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Her recent research was published in Current Opinions in Obstetrics and Gynecology.


Dr. Janelle Moulder, a faculty member in UNC OBGYN’s Division of Minimally Invasive Gynecologic Surgery, recently co-published in Current Opinions in Obstetrics and Gynecology an update and review on endometrial ablation as a treatment for abnormal uterine bleeding, including modifications to initial treatment guidelines and current data on long-term outcomes.

For the UNC OB-GYN blog, and re-posted here, she gives a rundown on the procedure, which many women start hearing about when they investigate solutions to their heavy menstrual bleeding.

Endometrial ablation | What women should know

Dr. Janelle Moulder

What is endometrial ablation?
Heavy menstrual bleeding can be very disruptive to a woman’s everyday life. Endometrial ablation is a relatively common procedure that surgically ablates or “burns” the lining of the uterus – or the endometrium. By destroying the lining, menstrual flow will be greatly reduced and sometimes even stopped for good.

What is the benefit to this method of controlling heavy uterine bleeding?
Over the last decade, the technique itself has changed considerably – it’s easier on the patient and easier for the physician to perform. This continues to be a successful treatment for abnormal uterine bleeding in many patients, and can be a less invasive alternative to a hysterectomy with fewer days away from work.

Who is a good candidate for ablation?
Women who are experiencing heavy bleeding, are finished having children, and have had a thorough evaluation of the source of abnormal bleeding would find this procedure helpful. With proper patient selection, ablation is considered to be very successful – 80 to 90% of patients see a reduction in their heavy menstrual flow. Providers should always talk to their patients about success rates, factors associated with failure, alternative treatments to ablation and the long-term consequences related to ablation.

Which patients are not right for this procedure?
I wouldn’t recommend this for my younger patients – women who are under 40 and who have not yet started a family – or who may desire more children. Ablation of the endometrial layer could have a very negative impact on a pregnancy that is able to implant after the procedure. If you have a history of pelvic pain or have a history of tubal ligation, this procedure could lead to an increase in pelvic pain. Finally, if your doctor thinks you may be at risk for endometrial hyperplasia or endometrial cancer, this procedure may limit the ability to make a diagnosis of these conditions in the future.

What should women consider before undergoing an endometrial ablation?
Endometrial ablation may make it harder for your doctor to sample the uterine lining if you have new abnormal bleeding in the future. And, it’s important to remember that it isn’t curative: between 13 to 30% of women will go on to have a hysterectomy, some within two years of the ablation.

Also, endometrial ablation isn’t a sterilization technique. Women should have reliable contraception following ablation, due to the procedure’s negative impact on a pregnancy, should one occur.