25:
336:
92:
504:
and 2) amenorrhea rate = the % of people that have their bleeding eliminated. According to the results of the
Randomized Controlled Trials performed for the FDA approval of the different treatment options, effectiveness Success Rates range from a high of 93% to a low of 67%, and the Amenorrhea Rates range from a high of 72% to a low of 22%.
281:, or mechanically with a series of metal tools of increasing diameter. After sufficient dilation, the ablation instrument is introduced into the uterine cavity, which is used to partially or fully destroy the endometrial lining. A hysteroscope may be used to assist in visualization of this process and/or ensure that final results are adequate.
503:
approves and audits clinical studies to test and evaluate the effectiveness of all endometrial ablation treatments. Two patient effectiveness outcomes are measured at one year following treatment: 1) success rate = the % of people who have their bleeding reduced to a normal period level or less,
300:
Ablation using
Electrocautery – The uterus is visualized using a thin scope. A tool is passed through the scope, such as a wire loop, a probe with a rollerball tip, or a probe with an electrode tip. The uterine lining is removed or destroyed by the device using electric current. General anesthesia is
288:
Ablation with cryotherapy – The uterus is probed with a chilled probe. The uterine lining is destroyed when the extreme cold at the probe's tip freezes it in pieces. The procedure can be monitored via ultrasound. It takes roughly six minutes to complete one freezing cycle. The size and shape of the
432:
observation. Once the appropriate time has passed or the appropriate depth of ice has been achieved, the cryoprobe is warmed to 37 °C. The cryoprobe is then repositioned to the untreated left uterine horn and the procedure is repeated. Finally, the cryoprobe is warmed and removed. In the Her
408:
fluid. The fluid is then slowly heated and the lining of the uterus is burned so that menstrual bleeding periods become less heavy and, in some cases, even stops. The fluid is then cooled and removed by special tubing to protect the external areas of the body from any burns. The average procedure
292:
Water-thermal ablation – For roughly 10 minutes, warm fluid is delivered into the uterus. The uterine lining is destroyed by the heat. This technique has the benefit of being usable in patients who have uteri that are shaped differently due to abnormal tissue growth. Lesions inside the uterus or
383:
that is created and contained inside a leak-proof ablation array that takes the shape of the uterine cavity. The hot membrane surface of the array ablates the endometrium. The
Minerva procedure is the fastest FDA approved treatment, average procedure time is 3.1 minutes from device insertion to
363:
that creates heat to ablate the endometrium. The
Novasure average procedure time is 5 minutes from device insertion to removal and is usually performed under local and/or conscious sedation anesthesia. Most patients leave the treatment center within one hour of treatment. In the Novasure
403:
device which is inserted into the uterus through the cervical canal, to help doctors safely confirm proper probe placement and to see the area they are treating. In this procedure, the doctor looks at the inside of the uterus with the hysteroscope and then fills the uterus with
296:
Ablation with
Radiofrequency – A flexible, triangular device inside the uterus is opened using a specialized tool. The uterine lining is destroyed by radiofrequency energy released by the ablation device in 1 to 2 minutes. After that, the device is taken out of the
206:
The primary indication for endometrial ablation is abnormal uterine bleeding, including chronic heavy menstrual bleeding, in premenopausal patients. Typically, these are patients for whom first-line medical therapy was unsuccessful or contraindicated.
471:
balloon, FDA approved in 1997, was taken off the market in
December 2015. This system utilized a heated saline filled balloon which was inserted into the uterine cavity to ablate the endometrium. The fluid was safely contained in a flexible and
597:
Bofill
Rodriguez, Magdalena; Dias, Sofia; Jordan, Vanessa; Lethaby, Anne; Lensen, Sarah F; Wise, Michelle R; Wilkinson, Jack; Brown, Julie; Farquhar, Cindy (2022-05-31). Cochrane Gynaecology and Fertility Group (ed.).
141:. The goal of the procedure is to decrease the amount of blood loss during menstrual periods. Endometrial ablation is most often employed in people with excessive menstrual bleeding, who do not wish to undergo a
973:
1054:
Cooper, K. G.; Bain, C.; Parkin, D. E. (1999). "Comparison of microwave endometrial ablation and transcervical resection of the endometrium for treatment of heavy menstrual loss: A randomised trial".
379:– Endometrial Ablation System, FDA approved in July 2015, is the first new FDA-approved surgical treatment for heavy menstrual bleeding in over 15 years. Minerva works by generating heat from
392:. Most patients leave the treatment center within one hour of treatment. In the Minerva randomized controlled trial for FDA approval, the success rate was 93% and amenorrhea rate was 72%.
343:
A number of treatment options are available, all of which work by inserting tools into the cervix to destroy the ablate the endometrium. Commonly used ablation systems include:
194:
after the procedure, and of pregnancies that do occur, complication risk is high. To reduce the associated mortality risks, it is often recommended for patients to adhere to
420:
and ablate the endometrium. Following the application of local anesthetic around the cervix, a physician uses ultrasound to guide the placement of a cryoprobe to the right
238:
to test for endometrial carcinoma, as this is an absolute contraindication to endometrial ablation. Some patients may also require further assessment of the uterus through
308:
After the ablation procedure is complete, any concomitant procedures that patients have opted for will also be completed. A common procedure after endometrial ablation is
152:
manner with no external incisions. Slender tools are inserted through the vagina and into the uterus. In some forms of the procedure, one of these tools may be a camera (
980:
1165:
1037:
226:
Prior to undergoing endometrial ablation, patients will go through a pre-procedure evaluation and risk assessment. Components of this often include
175:
treatment, either at a hospital, ambulatory surgery center, or physician office. Patients will most commonly undergo local and/or light sedative
107:
698:
35:
428:
is activated, reducing its temperature to minus 60 °C. The cryoprobe is kept in place while ice is formed in the uterine cavity, under
323:
Endometrial ablation is often an outpatient procedure that does not require an overnight hospital stay. Patients may experience cramping,
304:
Radiofrequency
Ablation – The uterus is filled with a device. The uterine lining is destroyed by the device's use of microwave energy.
312:
insertion, as effective contraception following endometrial ablation is highly recommended. Other concomitant procedures may include
409:
time is 26 minutes. In the HTA randomized controlled trial for FDA approval, the success rate was 68% and amenorrhea rate was 35%.
190:
are left intact. Due to the uterine changes that take place after undergoing ablation, patients are unlikely to be able to become
1158:
186:
over, thus reducing or eliminating future uterine bleeding. The patient's hormonal functions will remain unaffected because the
253:
Depending on the treatment that is chosen, endometrial ablation is sometimes conducted after treatment with hormones, such as
1109:
284:
The technique utilized to remove or destroy the endometrium varies with endometrial ablation operations. Options consist of:
848:
483:
Older methods utilize hysteroscopy to insert instruments into the uterus to destroy the lining under visualization using a
1409:
1151:
1125:
924:
1009:
542:
460:
rollerball tool to ablate the remaining underlying endometrium via cauterization. It is a proven procedure, being an
69:
301:
required for electrocautery ablation. Less frequently than other techniques, this ablation technique is employed.
1143:
1588:
1034:
1133:
500:
352:
149:
433:
Option randomized controlled trial for FDA approval, the success rate was 67% and amenorrhea rate was 22%.
416:– Endometrial Ablation System, FDA approved in 2001, is a treatment that creates sub-zero temperatures to
1562:
1292:
365:
243:
1175:
1529:
529:
234:(as current pregnancy is a contraindication to the procedure). All patients will undergo endometrial
47:
600:"Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis"
560:
51:
1539:
1506:
649:"Assessment of New Technology in the Treatment of Idiopathic Menorrhagia and Uterine Leiomyomata"
368:
for FDA approval, the success rate (i.e. bleeding reduced to a normal or less level) was 78% and
161:
798:
1297:
948:
575:
269:
Endometrial ablation may be done in-office or in an operating room. The procedure begins with
43:
1567:
1184:
648:
868:"Practical tips for office hysteroscopy and second-generation "global" endometrial ablation"
273:, which temporarily stretches the cervix to make room for the ablation instruments and/or
8:
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1205:
453:
389:
309:
247:
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293:
uterine fibroids are two conditions that can lead to the uterus becoming misshapen.
227:
211:
799:
Practice
Committee of American Society for Reproductive Medicine (November 2008).
1554:
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456:, or remove, the superficial endometrium. This is followed by a bi-polar
425:
417:
335:
278:
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156:) to assist with visualization. Other tools include those that harness
91:
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130:
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479:
membrane that conformed to most uterine cavity shapes and sizes.
1451:
1388:
1253:
1238:
512:
Although rare, the procedure can have complications including:
258:
138:
399:– Hydro-Thermal Ablation System, FDA approved in 2001, uses a
1516:
1192:
484:
187:
995:
Edited version of the original CME article that appeared in
277:
to enter the uterus. Dilation can be induced medically with
359:
array that is introduced into the uterine cavity, applying
183:
339:
Hysteroscopic image of an endometrial ablation procedure
214:
for undergoing endometrial ablation include endometrial
327:, and/or urinary changes during the recovery process.
218:, current pregnancy, and desire for future pregnancy.
1012:. Centre for Women's Health – Wichita. Archived from
699:"ACOG Practice Bulletin No. 81: Endometrial Ablation"
526:
Damage to the uterus (beyond the endometrial lining)
751:"Endometrial ablation: postoperative complications"
289:
uterus will determine how many cycles are required.
974:"Endometrial Ablation: More Choices, More Options"
801:"Indications and options for endometrial ablation"
697:ACOG Committee on Practice Bulletins (May 2007).
179:, or if necessary, general or spinal anesthesia.
1580:
1053:
129:is a surgical procedure that is used to remove (
1101:Gynecology Endoscopic Surgery: Current Concepts
198:methods after undergoing endometrial ablation.
171:The procedure is almost always performed as an
182:After the procedure, the endometrium heals by
96:Schematic illustration of endometrial ablation
1159:
1126:"FDA letter to Endometrial Ablation Industry"
755:American Journal of Obstetrics and Gynecology
355:approved in 2001, utilizes a metallized mesh
32:The examples and perspective in this article
436:Transcervical Resection of the Endometrium (
261:to reduce the thickness of the endometrium.
148:Endometrial ablation is typically done in a
971:
221:
1166:
1152:
953:University of Iowa Hospitals & Clinics
539:Sterilization and/or difficulty conceiving
145:, following unsuccessful medical therapy.
90:
1044:, by King's College Hospital. August 2013
816:
623:
448:through which a bi-polar radio frequency
70:Learn how and when to remove this message
872:Journal of Minimally Invasive Gynecology
384:removal, and is usually performed under
372:rate (i.e. bleeding eliminated) was 36%.
334:
865:
604:Cochrane Database of Systematic Reviews
1581:
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646:
925:"Endometrial ablation - Mayo Clinic"
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911:
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1174:Tests and procedures involving the
168:to destroy the endometrial lining.
13:
715:10.1097/01.AOG.0000263898.22544.cd
665:10.1097/01.AOG.0000232618.26261.75
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1600:
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789:
749:Sharp, Howard T. (October 2012).
737:
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647:Sharp, Howard T. (October 2006).
587:
543:Post-ablation tubal sterilization
818:10.1016/j.fertnstert.2008.08.059
507:
494:
246:, and/or removal of any current
23:
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1090:
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1002:
965:
949:"NovaSure endometrial ablation"
351:– Endometrial Ablation System,
230:, anesthesia evaluation, and a
1104:. Jaypee Brothers Publishers.
993:– via Boston Scientific.
941:
859:
841:
640:
616:10.1002/14651858.CD013180.pub2
464:procedure with rapid recovery.
442:Loop Resection with Rollerball
201:
1:
1068:10.1016/S0140-6736(99)04101-X
581:
390:conscious sedation anesthesia
1134:Food and Drug Administration
501:Food and Drug Administration
452:cutting loop is deployed to
330:
264:
7:
1563:Gynecologic ultrasonography
1293:Uterine artery embolization
703:Obstetrics & Gynecology
653:Obstetrics & Gynecology
549:
366:randomized controlled trial
46:, discuss the issue on the
10:
1605:
1176:female reproductive system
884:10.1016/j.jmig.2009.04.002
767:10.1016/j.ajog.2012.04.011
1553:
1530:Female genital mutilation
1515:
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1385:
1362:
1334:
1306:
1261:
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1191:
1182:
866:Glasser, Mark H. (2009).
530:Perforation of the uterus
361:bipolar electrical energy
113:
101:
89:
84:
561:Heavy menstrual bleeding
222:Preparation and planning
1540:Clitoral hood reduction
1507:Vaginal transplantation
853:www.hopkinsmedicine.org
805:Fertility and Sterility
162:high-energy radio waves
1098:Desai (January 2002).
849:"Endometrial Ablation"
340:
1589:Gynecological surgery
1568:Hysterosalpingography
1185:Gynecological surgery
1035:Hysteroscopic Surgery
999:. 2005; 30(12):35-40.
811:(5 Suppl): S236–240.
444:Ablation, utilizes a
338:
1354:Endometrial ablation
279:pharmacologic agents
164:, heated fluids, or
127:Endometrial ablation
85:Endometrial ablation
52:create a new article
44:improve this article
34:may not represent a
1405:Cervical conization
1288:Pelvic exenteration
1206:Salpingoophorectomy
1062:(9193): 1859–1863.
855:. 19 November 2019.
576:Asherman's syndrome
440:), commonly called
242:or saline infusion
1422:Cervical screening
1377:Uterine myomectomy
1349:Endometrial biopsy
1040:2014-06-12 at the
997:The Female Patient
929:www.mayoclinic.org
341:
150:minimally invasive
135:endometrial lining
1576:
1575:
1502:Vaginal wet mount
1446:
1445:
1417:Cervical cerclage
1326:Vacuum aspiration
1111:978-81-7179-937-4
1016:on 2 January 2015
972:James F. Carter.
325:vaginal discharge
271:cervical dilation
244:sonohysterography
212:contraindications
133:) or destroy the
124:
123:
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54:, as appropriate.
16:Medical procedure
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228:informed consent
166:cold temperature
117:edit on Wikidata
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1234:Tubal ligation
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1010:"HTA Ablation"
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36:worldwide view
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