Endometrial ablation: Is this a substitute for hysterectomy?

Objective: To review different techniques of endometrial ablation and suggest that ablation is a viable alternative to hysterectomy in the appropriate patient. Data Sources: Sources include original articles and reviews on various endometrial ablative techniques, comparing hysterectomy to ablation, and reviewing methods for choosing the appropriate candidate for endometrial ablation. Technical sources were written from 1981 to the present. Methods of Study Selection: Methods and follow-up studies of endometrial ablation techniques currently being used and studied. Fifty-one review articles including ablative techniques with long-term outcomes, patient selection criteria, and cost were used to formulate a strategy for appropriate selection of ablation over hysterectomy. Data Extraction and Synthesis: The methods reviewed include clinically-applied, ablative techniques with 'long-term' follow-up. Articles included patient selection and nonselection for ablation and reviews of hysterectomy versus ablation outcome data. Conclusion: While hysterectomy has been historically used for menorrhagia, endometrial ablation in the properly selected patient may become a widely used surgical technique.