Dr. Pulcinella Ruggero

Operative hysteroscopy

Endometrial ablation

Absolute Indications

  1. a.u.b.(abnormal uterine bleeding in perimenopause and menopause resistant to medical therapy
  2. Relapsing low-risk endometrial hyperplasias
  3. Contraindications to medical therapy


Related Indications

  • Patients on tamoxifen therapy for breast cancer with therapy-induced endouterine pathologies (polyps, hyperplasia, synechiae, etc.)


The aim of endometrial ablation is to reduce the number of hysterectomies (removal of the uterus), which is a demolishing operation and only appropriate in 20% of cases:

  • Removal of the entire endometrium together with the first 2-3 mm of myometrium (muscle tissue)
  • Maintaining an explorable uterine cavity in the future in the event of the emergence of new pathologies


Special features:

  • Difficult, 'free-hand' surgery, i.e. without reference points on which to rest the surgical gesture, which requires skill and experience.
  • It is necessary to have all 3 types of thermal loops
  • Prior to surgery, a diagnostic hysteroscopy with biopsy must be performed
  • It requires pharmacological preparation.


To undergo endometrial ablation the patient:

  1. Must be suffering from haemorrhagic metropathy (blood loss not resulting from organic disease)
  2. Must be over 40 years old
  3. He must have completed his procreative journey
  4. Refuses medical treatment because it has failed or is contraindicated
  5. No endometrial cancer or atypical hyperplasia


2-3 months after surgery, it is essential to perform a diagnostic hysteroscopy to prevent intrauterine synechiae (adhesions) 

The woman will have regular or scanty menstruation in 75% of cases. in 25% of cases, menstruation can be lost while not going through the menopause

However, fertility is lost due to the removal of the endometrium, which is the membrane where the fertilised egg nests and the pregnancy grows.