What is the role of endometrial ablation in the treatment of menorrhagia?

Updated: Dec 20, 2018
  • Author: Julia A Shaw, MD, MBA, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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A trial of medical therapy should have failed in patients considered for this therapy. The endometrium should be properly sampled and evaluated before surgery.

Patients should be pretreated with danazol or a GnRH analogue for 4-12 weeks before surgery to atrophy the endometrium, reducing surgical difficulty and time.

Success rates are similar to laser ablation techniques.

A 2005 Cochrane Review (updated in 2009) concluded that "overall the existing evidence suggests that success rates and complication profiles of newer techniques of ablation compare favorably with TCRE, although technical difficulties with new equipment need to be ironed out." [9, 42]

In an observational study (2010-2012) of 235 German women aged 18 years and older with menorrhagia and high or low surgical risk of complications who underwent radiofrequency endometrial ablation (RFEA), RFEA appeared to improve quality of life as well as resulted in high satisfaction among both groups of women. [43] High-risk factors included anemia, coagulopathy, anticoagulation, thromboembolism, obesity, transplantation, malignancy, and severe cardiovascular/pulmonary disease. [43]

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