5 - Surgical management of menstrual problems

Summary

The surgical options for the management of menstrual problems are chiefly endometrial ablation as a uterine conserving procedure and either total or subtotal hysterectomy, which can be performed by a number of routes. Endometrial ablation represents the most thoroughly evaluated surgical treatment to date. Endometrial techniques are divided into first generation and second generation techniques. First generation techniques include transcervical resection of the endometrium (TCRE), rollerball endometrial ablation (RBEA), and endometrial laser ablation (ELA). They offer the benefit of direct vision and require a fluid distension media. Second generation techniques are: thermal balloon ablation, microwave endometrial ablation (MEA), NovaSure, Hydro ThermAblator, and cryosurgical ablation. Second-generation ablative techniques have been evolved to simplify the technique and ideally place endometrial ablation safely in the hands of all gynaecologists. Total hysterectomy is the only surgical treatment for menstrual problems that guarantees amenorrhoea. Satisfaction with hysterectomy is higher than that with ablation.