What Are the Different Types of Endometrial Ablation?

The journey to relief from heavy periods (clinically referred to as “menorrhagia” or “heavy menstrual bleeding”) is different for everyone, but for many, it includes surgical treatment. If first-line medication therapy, such as hormonal birth control, including IUDs, or over-the-counter pain medications, fails to relieve your symptoms or is not tolerated, your OBGYN will likely move to the next tier of treatment. 

Surgical intervention is highly effective for women who no longer wish to become pregnant, but extensive procedures like hysterectomy, the removal of the uterus, are typically not the go-to surgery for HMB relief. In many cases, a more conservative procedure like endometrial ablation is chosen to avoid the higher risks and longer recovery times of a hysterectomy.¹ During an endometrial ablation, gynecologists use one of a variety of techniques to destroy the endometrium, the tissue lining your uterus that sheds blood during your period. The ablation treatment is associated with fewer surgical complications, less postoperative pain, and faster recovery timelines than hysterectomy.¹

Over time, endometrial ablation techniques have evolved to become more convenient and less invasive while still delivering positive results.² Second-generation techniques, also known as global endometrial ablations, are regarded as more efficient than older techniques that rely on intrauterine visualization (using a scope to visualize the uterus during treatment) to complete the surgery.¹ In fact, some second-generation techniques can be performed in the comfort of your doctor’s office without general anesthesia or sedation. If your doctor recommends an endometrial ablation for your heavy periods, the next step is discussing your options for treatment technique.

What Are the Different Endometrial Ablation Techniques?

Endometrial ablation techniques use either heat or cold-based technologies to destroy the endometrium. The most common second-generation modalities include:^3,4

• Hydrothermal. The hydrothermal method directly inserts heated fluid into the uterus to burn and destroy endometrial tissue. This technique can be more effective for patients with a misshapen uterus, as other techniques may use non-conforming liners that block full coverage of an irregular uterus. However, the direct contact between heated liquid and endometrium can cause unintentional burn injuries to tissues deeper in the uterus or surrounding structures.

• Thermal balloon. During balloon therapy, a small tube is placed into your uterus with a balloon that fills up with heated fluid. This method is similar to the hydrothermal technique, except a balloon liner is used to contain the liquid during the procedure. However, a thick or non-conforming liner may not be able to cover every surface of the uterus, leading to inconsistent ablation.

• Microwave. Microwave ablations use specific wavelengths of electromagnetic energy to kill endometrial tissue. During the procedure, microwaves are administered through a thin probe that directly heats the endometrium. As with any heat-based technique, microwave ablations may cause unintentional heat damage to nearby tissues and organs, potentially leading to scarring and long-term pelvic pain, as seen in Asherman’s Syndrome.⁵

• Radiofrequency. Using a flexible, expandable, and triangular electrical mesh, gynecologists can deliver radiofrequency (RF) energy to burn and destroy endometrial tissue throughout the uterus. However, the extreme heat may spread beyond the target area, creating additional burns and heat damage. Moreover, RF relies on the creation of adhesions inside the uterus to effectively reduce blood loss. This scarring can lead to painful complications, such as cyclic pelvic pain (CPP) or Asherman’s Syndrome, and limit your doctor’s ability to evaluate the inside of your uterus (“uterine cavity”) for potential cancer if you experience abnormal bleeding in the future.^5,6

• Cryotherapy. Cryotherapy is the only technique that does not use heat-based ablation methods. Instead, cooling technology is used to gently destroy endometrial tissue by freezing and dehydrating endometrial cells. Cryotherapy has a different healing response than heat-based ablation, which can result in minimal scarring inside the uterus.⁷ As with all endometrial ablations, treatment with cryotherapy can carry some risk of injury or need for reoperation.

Evaluating the Cryotherapy Advantage

The benefits of cryotherapy extend beyond the ablation treatment itself. The freezing agent, such as nitrous oxide, delivers a natural pain-relieving effect during the procedure by numbing the nerves located in the uterus, creating a well-tolerated treatment while also effectively destroying the endometrium. 

The Cerene® Cryotherapy Device provides a safe, effective, and well-tolerated endometrial cryoablation treatment for patients suffering from excessive blood loss and painful cramping. Cerene delivers many benefits for patients with heavy periods, including: 

• The procedure can be performed in the comfort and convenience of your doctor’s office 
• Natural pain relief during treatment; the median pain score during treatment is 2 on a 10-point scale⁸
• An ultra-thin, cavity-conforming liner that enables consistent ablation
• A thermally-insulating probe sheath that protects surrounding tissues from unintentional cryoablation
• Patients often recover quickly, with most returning to normal activities within 24 hours
• A significant reduction in heavy periods, with 90% of patients reporting normal, light, or no periods^†
• Access to the uterine cavity in 99% of patients for future diagnostic testing and clinical care⁹
• Significant relief from severe period cramping in 86% of patients^‡

Ask your doctor if Cerene cryotherapy could deliver the relief from heavy periods you’ve been looking for.

Learn more at https://www.cerene.com/patients/. 

† Patient-reported data are 1 year after treatment with durable results at 3 years

‡  Improvement reported one year after treatment for patients reporting severe/very severe period pain

Key Takeaways:

• Second-generation endometrial ablation techniques are often more efficient and convenient and less invasive than older ablation methods.
• Modern ablation techniques can use heated fluid, balloon therapy, microwave energy, radiofrequency, or cooling technology to destroy the endometrium, but heat-based techniques may increase the risk of unintentional burn injury, scar formation, and pelvic pain.
• Endometrial cryoablation with Cerene is a safe, efficient, and well-tolerated procedure that is clinically proven to reduce heavy bleeding and painful cramping.

Sources

1. Carugno, J. & Fatehi, M. (2023, January 4). Abdominal Hysterectomy. In StatPearls. StatPearls Publishing. Retrieved November 21, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK564366/. 
2. Bofill Rodriguez, M., Lethaby, A., Grigore, M., Brown, J., Hickey, M., & Farquhar, C. (2019). Endometrial resection and ablation techniques for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews, 1(1), CD001501.
3. Endometrial Ablation. (n.d.). Johns Hopkins Medicine. Retrieved November 16, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endometrial-ablation 
4. Endometrial Ablation. (2022, December 20). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/endometrial-ablation/about/pac-20393932 
5. Smikle, C., Yarrarapu, S.N.S., Khetarpal, S. (2022, June 27). Asherman Syndrome. In StatPearls. StatPearls Publishing. Retrieved November 21, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK448088/ 
6. Wortman M. (2017). Late-onset endometrial ablation failure. Case Reports in Women’s Health, 15, 11–28. 
7. Curlin HL, Cintron LC, Anderson TL. A Prospective, Multicenter, Clinical Trial Evaluating the Safety and Effectiveness of the Cerene Device to Treat Heavy Menstrual Bleeding. J Minim Invasive Gynecol. 2021 Apr;28(4):899-908. doi: 10.1016/j.jmig.2020.08.013. Epub 2020 Aug 22. PMID: 32835865.
8. Curlin, H. (2022). Endometrial ablation in the office setting. Contemporary OB/GYN Journal 67(11).
9. Curlin, H., Cholkeri-Singh, A., Leal, J.G.G., Anderson, T. (2022). Hysteroscopic Access and Uterine Cavity Evaluation 12 Months after Endometrial Ablation with the Cerene Cryotherapy Device. Journal of Minimally Invasive Gynecology 29(3), 440-447.