Endometrial ablation

Dr Ian Bickle and Dr Zishan Sheikh et al.

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 has 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.

  • benign uterine bleeding or menorrhagia
  • active genitourinary infection
  • malignant or pre-malignant uterine disease
  • recent pregnancy or desired future pregnancies
  • post-menopausal women

Various procedures and devices are available for performing endometrial ablation, each with their own advantages and limitations. All are done trans-vaginally via various probes inserted into the uterine cavity, usually with ultrasound guidance.

  • radio-frequency ablation
  • microwave ablation
    • probe generating microwaves heats and destroys uterine lining
  • cryoablation
    • endometrium frozen using the tip of a probe inserted in uterus
  • balloon ablation
    • balloon passed into the uterus and filled with heated material to destroy endometrium
  • electrosurgery
    • a resectoscope is inserted into the uterus with a wire loop or roller ball to remove the uterine lining
    • usually under general anesthesia
  • peri-operative complications 
    • uterine perforation

    • cervical laceration
    • uterine hemorrhage
    • severe cramping pelvic pain
    • urogenital infection
  • long-term complications

Normal post-ablation imaging findings

A range of findings can be considered as normal on early post-operative imaging following ablation:

  • US
    • distorted endometrial cavity
    • indistinct endometrial border
    • 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)
    • hematometra
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Article information

rID: 56894
System: Gynaecology
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:

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