Endometrial ablation is a minimally invasive endoscopic procedure targeting abnormal uterine bleeding, primarily by destroying the endometrial tissue to reduce menstrual flow. This therapy is suitable for women who do not respond to medication and have no structural uterine abnormalities, allowing preservation of the uterus while improving quality of life.
The procedure is usually performed in an outpatient or day surgery setting, utilizing high-frequency radio waves, cryotherapy, or thermal energy to selectively destroy the basal layer of the endometrium, avoiding impact on the myometrium. The effects can last for many years, but the risk of endometriosis or uterine cancer cannot be completely eliminated.
There are three main techniques: thermal energy ablation (such as radiofrequency or laser), cryoablation (using liquid nitrogen), and balloon tamponade. Thermal techniques heat tissue to 60-100°C, denaturing endometrial proteins; cryotherapy causes tissue necrosis through low temperatures (-40°C).
All techniques require prior dilation of the uterine cavity with media such as saline or gas to ensure even energy distribution. The mechanism of efficacy involves permanently reducing the regenerative capacity of the endometrium, although the basal layer may retain some regenerative potential, possibly necessitating repeat treatments.
Primarily used for patients with menorrhagia (menstrual blood loss >80ml per cycle) causing anemia or life interference. Suitable candidates must meet the following criteria:
Clinical guidelines recommend patients over 30 years old with normal uterine size (<7.5 weeks gestation size) as the primary candidates. Contraindications include uterine anomalies or severe infections.
The surgical process involves three stages: anesthesia (local or sedation), uterine dilation, and energy delivery. Instruments are inserted through the cervix into the uterine cavity, with energy output (e.g., laser power 50-150W) and application time (5-15 minutes) adjusted according to uterine size.
Postoperative care includes analgesics and antibiotics to prevent infection, with recovery typically taking 1-3 days. The treatment dosage should be tailored to uterine morphology; over-treatment may cause uterine perforation, while under-treatment results in poor efficacy.
Main advantages include:
Studies show that 70% of patients remain satisfied after five years, with a reduced risk of complications associated with open surgery. Suitable for women wishing to retain fertility but severely affected by menstrual bleeding impacting daily life.
Common short-term reactions include:
Serious complications include uterine perforation (<1%), infection, and tubal injury. Long-term effects may involve intrauterine adhesions or inadequate endometrial regeneration, potentially affecting future fertility.
Absolute contraindications include:
Relative contraindications include uterine anomalies, fibroids >3cm, or severe uterine retroversion. Preoperative assessment with hysteroscopy or ultrasound is necessary to confirm uterine morphology. Use is strictly prohibited in individuals allergic to cryogenic or thermal materials.
There is no direct interaction with hormone therapies (such as progestogens or GnRH analogs), but a gap of more than 3 months is recommended. When combined with anticoagulants, dosage adjustments are necessary to prevent bleeding risks.
Previous uterine surgeries (such as curettage) may affect instrument operation, requiring adjustments in energy parameters. Compared to uterine artery embolization, ablation is more suitable for menstrual issues rather than fibroid treatment.
Randomized controlled trials show that 90% of patients experience a >50% reduction in menstrual blood loss within 6 months, with 75% maintaining efficacy over 3 years. However, women over 45 may experience reduced effectiveness due to hormonal changes.
Long-term follow-up indicates no significant increase in endometrial cancer risk, but efficacy may decrease by 30% in women with adenomyosis. Regular monitoring of endometrial thickness every 2 years post-treatment is recommended.
Medical treatments include:
Invasive alternatives include:
When choosing, compare the durability of efficacy, recurrence rates, and future fertility desires. For example, progestin-containing intrauterine devices are reversible but need replacement every 5 years.
What daily activity restrictions are required after treatment?
During the first week post-treatment, avoid lifting heavy objects or vigorous exercise to prevent increased uterine bleeding. Light activities such as walking are recommended, gradually resuming normal exertion over 2-4 weeks. Sexual activity and tampon use should be avoided for at least 2 weeks, following medical advice.
How long does post-treatment bleeding typically last? How can discomfort be alleviated?
Some patients may experience irregular bleeding or discharge after treatment, usually lasting 1-2 weeks. Mild abdominal pain can be managed with prescribed analgesics. If bleeding exceeds one pad per hour or is accompanied by fever or foul-smelling discharge, immediate medical attention is necessary.
How does this therapy affect future pregnancy?
Endometrial ablation may create an environment less conducive to embryo implantation but does not guarantee sterilization. If pregnancy occurs, the risk of uterine rupture increases. Patients should confirm no fertility desire before treatment and discuss contraception options with their doctor.
What preoperative preparations are required?
Pre-treatment assessments include ultrasound and hysteroscopy to confirm normal uterine morphology and exclude fibroids or cancer. The procedure should be scheduled during specific menstrual cycle phases, with fasting for 6 hours and discontinuation of anticoagulants prior to surgery.
How is the durability of efficacy evaluated?
Approximately 70-80% of patients experience significant reductions in menstrual blood loss post-treatment, though individual recovery rates vary. Follow-up every 6-12 months is recommended to monitor changes, and additional treatments may be necessary if symptoms recur.
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