Endometrial ablation and resection are both typically performed as hysteroscopic procedures. This means the physician uses an endoscopic instrument called a hysteroscope to visually examine the uterus before removing the endometrium. Ablation and resection procedures differ slightly from one another:

• Endometrial ablation (EMA). The physician uses a hysteroscope to view the uterine lining. The lining is then cauterized with either an electrosurgical tip called a “rollerball” (similar to a tool used to smooth wallpaper) or with a laser.
  
  The Food and Drug Administration (FDA) has approved several other forms of ablation therapy. They include:
  
• • Hydrothermal ablation. This method uses heat to destroy the lining of the uterus. A computer-controlled device directs a hot saline solution to target and destroy the innermost layer of the endometrium. The procedure starts with the physician inserting a hysteroscope and tubing through the vagina into the uterus. Saline (salt water) is heated to 194 degrees Fahrenheit (90 degrees Celsius), and a pump circulates the fluid through the HTA system and uterus for 10 minutes. This destroys the endometrium. Hydrothermal ablation is the therapy of choice for women who have a uterus that is abnormally shaped.
    
    
  • Cryoablation therapy. This method uses cold to destroy the uterine lining. A thin probe attached to a cooling unit freezes and destroys the uterine lining. The probe is inserted through the cervix into the uterus, and the tip of the probe is cooled to -4 degrees Fahrenheit (-20 degrees Celsius) before it is applied to the uterine lining. Cryoablation is often the primary choice of procedure for women seeking surgery that requires minimal anesthesia and no hospital time.
    
    
  • Radiofrequency ablation. Uses radiofrequency energy to destroy the lining of the uterus via a handheld catheter. The heat is delivered in about 90 seconds, significantly less time than is necessary for other endometrial ablation treatments. This technique does not require premedication, making it the procedure of choice for women who wish to avoid such medications. However, it can only be used in women who have normal uterine cavities.
    
    
  • Microwave ablation. Approved in 2003, this variation delivers microwave energy through a slender tube inserted in the uterus. The microwaves create heat that destroys the endometrium within minutes. It is the therapy of choice in women who have fibroids of less than 3 centimeters.
    
    
  Other types of ablation under development include techniques using phototherapy (light).
  
  
• Endometrial resection (EMR). The physician uses a hysteroscope to view the uterine cavity and removes the lining with an electrosurgical wire loop. In addition to removing the uterine lining, a quarter-inch of the uterus’ underlying muscle is removed.

All of these methods require significant technical expertise and should be performed only by experienced physicians.

A newer form of ablation that is considered easier to perform has recently emerged. Blind endometrial ablation – also known as uterine balloon therapy – is a procedure in which a soft, flexible balloon attached to a thin probe is inserted through the vagina and into the uterus. Sterile, hot fluid is used to expand the balloon to fit the contours of the uterus. The fluid then is heated to 189 degrees Fahrenheit (87 degrees Celsius). After about eight minutes, the heat destroys the uterine lining. The fluid is then withdrawn, causing the balloon to deflate before the device is removed.

Advantages of balloon therapy include the fact that no visualization is necessary, the instrument is smaller than instruments used in some other procedures, and less specialized skill is required. Balloon therapy can be performed on an outpatient basis, and recovery time is less than one day. However, balloon therapy also has drawbacks. It cannot be used if the uterus is abnormally shaped or has polyps or fibroids. In addition, balloon therapy is not always as effective as hysteroscopic techniques.