Synopsis
Compare endometrial ablation with hysterectomy after appropriate medical and structural treatment, confirm reproductive and endometrial suitability, and support informed consent about effectiveness, recovery, complications and future surveillance.
- Consider specialist procedural care when HMB is severe, medical treatment is declined or unsuccessful, or a structural lesion needs direct treatment; do not jump from one short tablet trial to definitive surgery.
- Endometrial ablation destroys the uterine lining to reduce bleeding while leaving the uterus in place; it is suitable only when future pregnancy is not desired and the cavity is appropriate.
- Ablation is not contraception. Use reliable contraception afterwards because pregnancy remains possible and carries increased ectopic, miscarriage, preterm and abnormal placentation risk.
Key red flags
Future pregnancy desire, current pregnancy or uncertainty about completing fertility makes endometrial ablation inappropriate because subsequent pregnancy can be dangerous.
Increasing pain, fever, ileus, urinary leakage, haematuria or renal dysfunction after hysterectomy may indicate bowel, bladder or ureter injury.
Investigation priorities
Confirm that pregnancy is absent and future pregnancy is not desired before ablation or hysterectomy.
Management branches
HMB remains unacceptable after adequate medical and lesion-specific management or the patient declines those options.
- Reconfirm diagnosis, pain mechanism, endometrial assessment, cavity anatomy, prior treatment and the patient’s fertility and bleeding priorities.
- Compare ablation’s shorter recovery and retreatment risk with hysterectomy’s definitive bleeding control and greater operative recovery and complication burden.