Hysteroscopic Thermal Ablation of Endometrium Hysteroscopic endometrial ablation is an alternative to hysterectomy for the treatment of menorrhagia (heavy menstrual bleeding). It is a minimally invasive surgical procedure performed by gynecologists and obstetricians in an outpatient setting and reduces or totally eliminates monthly periods in women by removing or destroying the endometrium (uterine lining). The surgery may cause permanent sterility but that is not the purpose and sterility cannot be guaranteed. Unlike hysterectomy where the uterus is removed, endometrial ablation leaves the uterus intact, surgery is less invasive, recovery is shorter, and there are fewer complications. During a 10 year period, 90% of the women having this procedure had very scanty or no monthly menses (periods). Some patients require repeat ablation because of persistent or recurring menorrhagia. Endometrial ablation is done during the menstrual cycle when the endometrial lining is thinnest. A variety of methods may be used to destroy the lining. These include laser energy, radio waves, electricity, hot water, freezing, and a heated loop. Whatever the method, endometrial ablation is done with the help of a hysteroscope to visualize the inside of the uterus. (see hysteroscope) This procedure may be performed under local anesthetic, and most patients are discharged in a matter of hours. For about six weeks following the endometrial ablation, patients have a brownish to slightly bloody discharge. The procedure is well tolerated in most women; some have cramping and fatigue for several days. Over 90 percent of the patients are back to normal activity within 4-5 days after surgery. Patients should consult their physician for a complete explanation of the procedure along with its associated risks and complications.