Endometrial ablation and endometrial resection are procedures to remove the endometrium, which is the lining of the uterus. These procedures are used to treat chronic, abnormally heavy or prolonged menstrual periods, a condition known as dysfunctional uterine bleeding (DUB). Types of DUB include menorrhagia and metrorrhagia.

DUB is generally diagnosed when abnormal bleeding interferes with everyday activities and no other physical cause for the bleeding can be identified. One in five women experience heavy bleeding during childbearing years, according to the American College of Obstetricians and Gynecologists. It most often affects women between the ages of 40 and 50 years, when hormone fluctuations occur as a woman nears menopause. The loss of too much blood can result in anemia, a condition in which the blood is deficient in red blood cells, hemoglobin or total volume. Anemia can cause jaundice (yellowing of the skin and whites of the eyes), fatigue and low energy. In severe cases of anemia, the patient may require a blood transfusion.

In many cases, hormone drugs such as birth control pills or a levonorgestrel-releasing IUD can help reduce the bleeding. If hormonal therapy fails, surgery – in the form of a hysterectomy (surgical removal of the uterus), or endometrial ablation or resection – may be necessary. Endometrial ablation and resection are used to remove or destroy the endometrium, the functional layer of the uterine wall that grows during the month and then sheds as the menstrual flow at the end of the cycle. Ablation and resection can stop or dramatically decrease the flow of blood during menstruation and may prevent a hysterectomy.

Endometrial resection is a surgical procedure that removes the endometrial lining with an electrosurgical wire loop. Resection can be used in women who have heavy bleeding but do not have any other underlying uterine problems. Resection appears to have a higher success rate in reducing bleeding in older women than younger women.

Endometrial ablation differs from resection in the manner in which the lining is removed. Several different methods may be used for endometrial ablation, including laser, electrocautery instrument and thermal balloon to remove or destroy the uterus lining. Ablation can be performed with the following elements:

• Electricity
• Laser
• Heat
• Cold
• Microwaves
• Radiofrequency energy

In each of these procedures, the uterine lining is destroyed to reduce excessive bleeding. The uterus is preserved, but a woman is generally not able to become pregnant. In addition, she is likely to experience little or no menstrual flow. In some cases, menstrual flow will resume at a later time, although typically not in the form of heavy bleeding associated with DUB.

In recent years, endometrial ablation and endometrial resection increasingly have replaced hysterectomies as the procedure of choice in treating women with DUB. Ablation and resection cost less, do not require incisions, require shorter hospital stays and have lower mortality rates than hysterectomies. However, ablation and resection are not effective for women who have underlying uterine problems such as large fibroids, polyps or endometrial cancer.

Endometrial ablation and resection should not be used on pregnant women. Other conditions that prevent the procedure include having an IUD in place, active genital or urinary tract infections or a history of classical Caesarean section, according to the Food and Drug Administration (FDA).

There may be additional restrictions depending on the type of procedure. For example, microwave ablation should be not used in a patient who has pelvic inflammatory disease, a history of dilation and curettage or a myometrium (outer uterine layer) thinner than 10 millimeters anywhere in the uterus, according to the FDA. A gynecologist can provide additional details about whether endometrial ablation and resection may be an appropriate treatment option.