Pros and Cons of ablation vs hysterectomy

One of the surgical techniques for the management of heavy menstrual cycles is endometrial ablation.  In history, uterus removal has been the only surgical treatment of choice for many women suffering from severe or heavy bleeding, and the procedure is termed as hysterectomy. In the last decade, endometrial ablation has been introduced to provide an alternate solution to hysterectomy by removing or cutting the uterine lining locally.

With the methodologies of the first century and some of the techniques of the second generation, a viewing tube, the width of a pencil, moves across the vagina and cervix to the womb. A small camera transmits photographs of the operation to a TV monitor, and instruments can be pushed through the tube. With first-generation techniques, the surgeon uses a hot wire loop to cut the lining of the uterus.

Methods of the second generation are more automated and use heat energy applied to the uterine lining based on the cavity's shape and scale. Depending on the process, an instrument is passed into the uterus with the second generation, but this does not have a camera attached. These techniques are also used to perform a hysteroscopy just before the actual ablation treatment. Hysteroscopy is a procedure where a camera-based telescope is inserted into the uterine cavity via the vagina and cervix, enabling the surgeon to look to make sure that the ablation treatment is secure. The operation can be done in outpatients under local anesthetic using the second-generation techniques, and most patients are discharged at home after a few hours. 

Around 10% of patients who undergo endometrial ablation fully avoid menstruation. Bleeding is effectively decreased by a further 70 percent. Many women who suffer from the pre-menstrual syndrome or have painful cycles also report substantial change. It can take from 8 and 12 months for the results of endometrial ablation to be certain. The effects are assumed to be permanent, but menstruation may return in some women, particularly those who have had this procedure under the age of 40 years. Your gynecologist can recommend a second procedure or advise you on other alternative treatments, including hysterectomy if that happens.

Overall, 70% to 80% of patients are pleased with the procedure. Complications may often occur, but severe complications are rare, such as fluid overload, uterine perforation, heat damage to other internal organs, and hemorrhage.