January 15, 2017 Liza Colimon, MD An Endometrial Ablation is a procedure offered to women who have heavy menstrual bleeding and do not want to undergo a hysterectomy or prefer less invasive management options prior to considering hysterectomy. Various methods can be performed to destroy the basalis layer (lining of the uterus that has glandular tissue which bleeds monthly at the time of your menses) of the uterine lining to prevent heavy bleeding. A hysteroscope is first used to visualize inside the uterine cavity. All instruments are placed through the vagina and do not require vaginal or abdominal incisions. If polyps or fibroids exist, they will be removed hysteroscopically. If they are 2-3 cm or less they may be left in place depending on the type of ablation you undergo. The uterine lining may also be resected to prevent heavy bleeding. This procedure is performed with the hysteroscope and requires quite a bit of skill. Hot water may be used to ablate the uterine lining (Hydrothermal or Thermachoice). Bipolar electricity may also be used to burn the uterine lining. This procedure is called Novasure Ablation. If lager fibroids are present and your surgeon is skilled they may choose to perform and endometrial resection or rollerball ablation. These are older, traditional methods requiring more skill but very useful in certain circumstances.