Endometrial ablation is a surgical technique useful in cases of excessive and abnormal uterine bleeding (not due to cancer) and is the destruction of the endometrium, the lining inside the uterus.
The main objective of the ablation is therefore the reduction of the amount and duration of menstrual flow (hypomenorrhea quantifiable in 75-80% of the treatments), until disappearance of its possible (amenorrhea (20-25%).

Obviously endometrial ablation aims to eliminate the problem of heavy menstruation. This goal is considered achieved with obtaining different situations:
• Absence of menstruation (AMENORRHEA 20-25%)
• Menses scanty (HYPOMENORRHEA) or normal (75-80%)

The causes of menorrhagia (heavy menstrual bleeding) and Hypermenorrhea are very often
• ORGANIC (polyps, myomas, tumors, infections or abortions)
• FUNCTIONAL (coagulopathy, hypothyroidism, cirrhosis, abnormalities of the pituitary-ovary). The most abundant haemorrhagic manifestations is a functional nature (85%)
• IATROGENIC (by taking steroids, certain medications, and applying IUD).

Menorrhagia (heavy menstrual bleeding) can have significant impact on the quality of life of women and its management depends on individual experience.
Both medical and surgical therapies can offer solutions to the problem of excessive and abnormal bleeding.

The MEDICAL THERAPY does not allow most of the time very long cycles of treatment, both for the many side effects that often accompany the drugs, and because it is subject to the terms and conditions of the woman who, being many times in an age in which they are present metabolic or cardiovascular diseases, is forced to a limited use of the drug, or has clear contraindication to its use that make it impossible intake. Moreover, in many studies, the oral medical therapy was less effective than surgical.

The SURGICAL MANAGEMENT (HYSTERECTOMY) with its risks, costs and complications raises the question of the validity of destructive surgery, considering that in 20% of these interventions, there was a "normal histology."
The ablation therapeutic option allows to preserve the uterus, providing results equally effective, with very minor risks, and with considerably lower costs both from the point of view of health care costs, but above all from the point of view of the patient, with a day care in day-Surgery and immediate return to their home, improving the quality of life.

The main indication to perform endometrial ablation is the presence of heavy periods, can not be controlled in a lasting way by drug therapy.

It's better to think at the endometrial ablation if the woman has more than 40 years: in general the results are better the more the woman is close to menopause, because the endometrium reform more slowly from the deeper parts of endometrial glands, not removed by ablation hysteroscopy or not reached by heat when using ablation with the balloon. However ablation can be performed in women younger than if the couple does not want more pregnancies.

Endometrial ablation can then be considered when:
- The bleeding has significant impact on quality of life
- The woman does not want more pregnancies
- The uterus is normal or there is the presence of fibroids small

They are therefore to be considered as ABSOLUTE INDICATIONS
1) A.U.B. (abnormal uterine bleeding in perimenopausal and menopausal resistant to medical therapy)
2) low-risk endometrial hyperplasia relapsing
3) contraindications to medical therapy

Are considered instead INDICATIONS FOR
1) AUB (abnormal uterine bleeding) for the presence of submucosal myomas or polyps (after removal of the same)
2) Patients receiving tamoxifen for breast cancer with endouterine induced pathologies (polyps, hyperplasia, synechiae etc..etc ..)
3) A.U.B. in patients who carry H.R.T. (hormone replacement therapy in menopause) or who are being treated for breast cancer

Before proceeding endometrial ablation, it is important to make an accurate diagnosis with a series of tests, for which are required:

• endometrial biopsy (excluding cancer)

• Pap-test

• Transvaginal ultrasound or hysteroscopy to analyze well the inside of the uterus and discard the possibility of uterine polyps or fibroids (which also may be due to heavy bleeding and you can definitely solve more easily endometrial ablation )

• Pregnancy test.
to exclude the presence of those diseases which would lead to choose other therapeutic options

Before surgery are still removed uterine contraceptive devices and in young premenopausal women is recommended hormone therapy in the previous weeks with the aim of minimizing the endometrium, make it thinner: this condition appears to be an important priority of the success of the ablation.
In fact, for years we perform a preliminary resectoscopy in order to reduce the height of the endometrium to promote optimal ablation.

The literature describes some risks and complications of this procedure (although very rare), as

• The perforation of the uterine wall involuntary
• Damage to the cervix by hyperthermia
• Bleeding
• Infections
• Complications anesthetic
• Synechiae and ematometra

A risk is also to future infertility (though not certain).
The endometrium can also reform itself and then give life again to excessive bleeding not otherwise treatable

Contraindications major plan to not perform this procedure in pregnant women, who want to have a child in the future, or in the case of infection of the genitals in progress. Endometrial ablation is also not recommended in women who have heavy menstrual pain after menopause or who have recently given birth. It is also not a first-line treatment, but is done only when the medical and hormonal therapies (drugs) have proved ineffective in controlling the bleeding.
In practice it is not advisable endometrial ablation if there is a uterine tumor pathology, or in the case of:
• uterus large volume
• excessive thickening of the endometrium
representing indication for surgical treatment demolitive (hysterectomy).

A. ABLATION HEAT WITH BALLOON
Is performed with a catheter that, at its end, has a balloon latex. Once introduced the catheter into the uterine cavity stretches the balloon with glucose or glycine, and rises the temperature of the solution up to 90 degrees. It will be determined so necrosis of the endometrium for a thickness of 4 mm.

B. HYDRO THERMOABLATION
Approved by the FDA in 2001, consists in the circulation of water heated to 90 ° degrees for 10 minutes inside the uterus. Is performed under control hysteroscopy.

C. CRYOABLATION
Approved by the FDA in 2001, consists in the application of a device at the tip of which comes a heating of 120 ° degrees. Requires 2 cycles of treatment, of 4-6 minutes each. Can treat cavity 'with uterine irregularities. It 'a safe and effective procedure in the treatment of dysfunctional uterine bleeding. Its advantages include ease of technical performance, direct view of the ultrasound ablation depth, a little anesthetic, and to avoid potential complications related to the means of distension.

D. RADIO FREQUENCY ABLATION BIPOLAR

E. ABLATION MICROWAVE

F. ABLATION RESECTOSCOPIC
Hysteroscopy is performed under control, stretching the uterine cavity with a liquid. Distension obtained allows to see well the interior walls of the uterus. So with a special tool, that is introduced into the uterus through the vagina (resectoscope), you size the lining of the uterine cavity as a lining (endometrium).
Although the reported incidence is still very low (and varies from 1% to 4%), this type of ablation is burdened by important complications, which include uterine perforation, hemorrhage, the risk of intestinal lesion and overload of liquid used for uterine distension, being closely related to the experience of the operator

Of course there is no absolute certainty of healing (something which is common to most of the interventions and the whole medicine in general), but on average the intervention has an efficacy of 90%.

One of the possible results of the treatment (absence of menstruation) is not to be lived with anguish and frustration by women who had not understood well the possibility of occurrence of amenorrhea (which occurs in about 25% of cases), and that this does not mean it started menopause In fact the absence of menstruation does not mean that started the menopause. The ovarian activity in fact continues as before surgery, and only with its cessation menopause starts.
Also after ablation can no longer get pregnant. Have eliminated or burned the endometrium no longer allows a possible embryo lurk in the uterine cavity. Nevertheless there is no complete safety contraceptive surgery ablation, as small pieces of endometrium may remain or reforming a distance of time, allowing the implantation of the embryo.