Endometrial resection and ablation techniques for heavy menstrual bleeding

摘要

Heavy menstrual bleeding (HMB) is a significant health problem in premenopausal women; it can reduce their quality of life and can cause social disruption and physical problems such as iron deficiency anaemia. First‐line treatment has traditionally consisted of medical therapy (hormonal and non‐hormonal), but this is not always successful in reducing menstrual bleeding to acceptable levels. Hysterectomy is a definitive treatment, but it is more costly and carries some risk. Endometrial ablation may be an alternative to hysterectomy that preserves the uterus. Many techniques have been developed to 'ablate' (remove) the lining of the endometrium. First‐generation techniques require visualisation of the uterus with a hysteroscope during the procedure; although it is safe, this procedure requires specific technical skills. Newer techniques for endometrial ablation (second‐ and third‐generation techniques) have been developed that are quicker than previous approaches because they do not require hysteroscopic visualisation during the procedure.