The indication is to treat dysfunctional uterine bleeding (no intrauterine pathology). A 2019 Cochrane Review concluded that women undergoing thermal ablation techniques had a similar reduction in bleeding and were as satisfied as women having hysteroscopic resection of the endometrium at 1 year, and 2–5 years. However, they concluded that there was insufficient evidence to show which second-generation approaches were superior to others and to reveal the efficacy and safety of third-generation approaches versus first and second generation techniques.
They were also unable to conclude whether perforation rates differed between first- and second-generation techniques.
- General anaesthetic is not routinely required so they can be performed in an outpatient setting.
- The procedure is quicker and easier to perform.
There have been recent developments in the devices for achieving endometrial ablation using different energy sources, including hot water, cryocautery and radio frequency energy.
The main two systems used in the UK currently are bipolar radio frequency energy (NovaSure®) and balloon thermal ablations (Thermablate®).
Other systems in use include the Minitouch, the Minerva, Thermachoice and Librata.