Purpose of review: Long-term data from the studies of various endometrial ablation techniques are beginning to emerge. This review appraises the current literature on endometrial ablation for heavy menstrual bleeding, with particular emphasis on second-generation techniques, and their effectiveness, rates of repeat and further interventions and adverse events occurring 1 year or more after the procedure.
Recent findings: Second-generation, nonhysteroscopic techniques are marginally superior to hysteroscopic approaches, in terms of amenorrhoea, refractory menorrhagia and satisfaction rates. Hysterectomy rates are around 20% at 2 years, with a further 3–5% having repeat ablations. Bipolar radiofrequency and microwave ablation give rise to higher amenorrhoea rates than thermal balloon ablation, and are less likely to require repeat or further intervention.
Summary: Endometrial ablation is a well tolerated and effective procedure for the treatment of heavy menstrual bleeding. Second-generation techniques provide greater benefit than hysteroscopic techniques, with shorter procedural times and the possibility of outpatient treatment. Chronic pelvic pain frequently resolves after ablation, but can also develop de novo. Pregnancy outcomes are poor and continuing contraception is recommended.