Updates in Endometrial Ablation: Office Approaches

fluid overload and electrolyte disturbances. Since the 1990s, the FDA has approved several nonresectoscopic endometrial ablation systems (often referred to as global endometrial ablation), which have short ablation cycles and require less user expertise with similar effectiveness compared with resectoscopic methods.1 Although patient satisfaction between resectoscopic and nonresectoscopic techniques seems to be equivalent, nonresectoscopic techniques are associated with shorter operative times and are more often performed under local anesthesia.1 As such, they are much more feasible for use in the outpatient setting. Success of endometrial ablation is primarily measured by patient satisfaction rates and rates of additional intervention including hysterectomy in the months and years after the procedure. It is therefore critical to properly identify candidates for endometrial ablation and counsel them regarding risk factors for dissatisfaction and for subsequent hysterectomy. This article aims to review available nonresectoscopic endometrial ablation systems, to identify ideal candidates for this procedure, to optimize success in the outpatient setting, and to describe risk factors for endometrial ablation failure. Endometrial ablation is an attractive management option for many premenopausal patients with heavy menstrual bleeding as an alternative to medical therapy or hysterectomy. The goal of endometrial ablation is to reduce menstrual bleeding by local destruction of the endometrium. Resectoscopic endometrial ablation, although an effective treatment for heavy menstrual bleeding, requires specific hysteroscopic skills by the operator and carries the risk of Updates in Endometrial Ablation: Office Approaches