• Endometrial ablation involves destroying the endometrium (lining) and the superficial myometrium (muscle) of the uterus. The process also prevents the woman from having children in the future. The technique was first developed in the mid-1990s, and has since evolved.
• First generation techniques consisted of transcervical resection with an electrosurgical loop to destroy tissue or the use of a heated rollerball. These require highly-trained surgeons and are now recommended only where hysteroscopic myomectomy is needed.
• Second generation techniques were developed to be simpler to use, and are now recommended as standard. These include methods using thermal balloons, microwaves, radiowaves, and cryotherapy.
• There is good evidence from controlled trials that endometrial ablation techniques lead to clinically significant improvements in menstrual blood loss as well as improvements in quality of life. Endometrial ablation is generally preferred to hysterectomy in most women, as it is a less drastic option. It is recommended by the National Institute for Health and Clinical Excellence, provided:
• Bleeding is having a severe negative impact on the woman's quality of life.
• Pharmaceutical treatment has been tried but was ineffective, or was not suitable, and a surgical solution is appropriate.
• The woman does not want to conceive in the future (although contraception may still be needed).
• The uterus is normal or has fibroids less than 3 cm in diameter, or is no bigger than a 10 week pregnancy.

[National Collaborating Centre for Women's and Children's Health, 2007]