**12. Endometrial ablation**

Endometrial ablation is a minimally invasive surgical procedure for the treatment of the common problem of heavy menstrual bleeding. In general, menstruation totaling over 80 ml is considered heavy or excessive.

Several endometrial ablation devices have been approved for women with heavy menstrual bleeding due to benign causes provided that childbearing is complete.

Endometrial ablation device methodology includes heat energy created by heated gas, radiofrequency, free-flowing heated saline that circulates within the endometrial cavity, microwave energy, heated fluid within a balloon, heated water vapor that circulates within the uterus, and extreme cold treatment by nitrous oxide within balloons. All these devices are manipulated into the uterus using an appropriate hand piece.

Potential benefits of endometrial ablation include reduction in menstrual bleeding and improvement in the quality of life. On the other hand, side effects include cramping pain, vaginal discharge, bleeding, and spotting [46].

Late complications following endometrial ablation include post-ablation tubal sterilization syndrome and hematometra due to cervical stenosis [46].

Endometrial ablation does not protect women from future pregnancies. Pregnancy following ablation is hazardous for both the mother and fetus. Sterilization or contraception until menopause should be used. In addition, there may be future difficulty in diagnosing endometrial cancer due to the scarring of the endometrial cavity. Amenorrhea following treatment is not unusual [46].

Endometrial ablation is a more conservative alternative to all types of hysterectomy for dysfunctional uterine bleeding. It is less demanding financially and is associated with shorter hospital stay, but the original indication for its performance is not always resolved. Studies suggest that up to 25% of women undergoing endometrial ablation require further attention, in the form of medications, repeat ablation, or hysterectomy for unacceptable degrees of dysfunctional uterine bleeding [46].

Non-hormonal medications with or without hormonal therapy should be considered before trying more invasive treatments such as endometrial ablation or hysterectomy. Both the American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence in the United Kingdom recommend medical therapy for the initial treatment of patients with excessive menstrual blood loss [47, 48].

Endometrial ablation modalities are now a second-line treatment choice after attempting medical therapy that fails for any reason, with the availability of a wide range of well-tested effective devices in use that directly deliver energy to the uterine endometrium. These modalities have demonstrated high levels of success with minimal complications when applied to appropriately selected patients [49, 50].

Hysterectomy remains a definitive surgical modality for patients with dysfunctional uterine bleeding. All types of hysterectomy are considered a mainstay of alternative options for patients where the medical approach proves to be ineffective or is associated with intolerable side effects [51].

*Alternatives to Hysterectomy for Dysfunctional Uterine Bleeding DOI: http://dx.doi.org/10.5772/intechopen.113758*
