Menorrhagia: the role of endometrial ablation

Menorrhagia has an enormous impact on many women's lives and, until the early 1990s, the only treatments widely available were relatively ineffective oral therapies and hysterectomy. Since then, women seeking treatment for menorrhagia have also been able to choose from a much wider range of treatments, including endometrial resection or ablation and the levonorgestrel-releasing intra-uterine device. Hysteroscopic resection/ablation has been extensively studied and compared with other medical and surgical treatments in well-conducted randomised trials. Long-term follow-up and safety data are also available. More recently, a potentially bewildering number of new surgical therapies have also become available, for which in some cases much less information is available. These treatments have been developed with the aim of providing a quick, safe way of destroying the endometrium, without requiring the surgical skills or general anaesthesia needed for hysteroscopic ablation/resection. However, as experience is gained with the use of progestogen-releasing devices for the treatment of menorrhagia, some question whether there is much role for endometrial ablation in any form. This review considers each currently available technology individually, assesses the role of endometrial ablation in the treatment of menorrhagia, and suggests what characteristics are required of the ideal ablation device. (C) 2004 Published by Elsevier B.V.