Endometrial ablation is a minimally invasive surgical procedure that involves the destruction of the uterine endometrium commonly performed for menorrhagia in premenopausal or perimenopausal women.
It has evolved as an alternative to hysterectomy and is associated with good outcomes and patient satisfaction 1. Radiologists may encounter complications of ablation on pelvic imaging and so need to be aware of possible findings.
On this page:
Indications
benign uterine bleeding or menorrhagia
Contraindications
active genitourinary infection
malignant or premalignant uterine disease
recent pregnancy or desired future pregnancies
postmenopausal women
Procedure
Technique
Various procedures and devices are available for performing endometrial ablation, each with their own advantages and limitations. All are done transvaginally via various probes inserted into the uterine cavity, usually with ultrasound guidance.
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microwave ablation
probe generating microwaves heats and destroys the uterine lining
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cryoablation
endometrium frozen using the tip of a probe inserted in the uterus
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balloon ablation
balloon passed into the uterus and filled with heated material to destroy the endometrium
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electrosurgery
a resectoscope is inserted into the uterus with a wire loop or roller ball to remove the uterine lining
usually under general anesthesia
Complications
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perioperative complications
cervical laceration
uterine hemorrhage
severe cramping pelvic pain
urogenital infection
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long-term complications
painful obstructed menses
adenomyosis (up to 43% of patients on uterine histology) 4
Normal post-ablation imaging findings
A range of findings can be considered normal on early postoperative imaging following ablation:
Ultrasound
distorted endometrial cavity
intact or regenerating endometrium
islands of endometrial tissue
thickened endometrium >3 mm is more frequently associated with symptoms
MRI
residual or regenerating endometrium may be seen, commonly towards the tubal ostia
endometrium within the junctional zone or myometrium
widening of the junctional zone (up to 3 months post-ablation)