• endometrial ablation;
  • levonorgestrel-releasing intrauterine system;
  • menorrhagia;
  • uterine artery embolisation

Key content

  • Heavy menstrual bleeding remains a major problem for some women.
  • Hysterectomy is the leading treatment for this condition but it is recognised to have some serious complications.
  • First-generation endometrial ablation techniques have a steep learning curve and are carried out under hysteroscopic visualisation.
  • Second-generation techniques are simpler and have lower complication rates, lower analgesia requirements and potential for outpatient use.
  • Individual assessment is important in deciding the route and method of treatment for heavy menstrual bleeding, taking clinical factors into consideration.

Learning objectives

  • To know about the various options currently available for endometrial ablation.
  • To learn about the clinical application, advantages and limitations of various methods of endometrial ablation.
  • To be able to make an informed choice when deciding which modality to use.

Ethical issues

  • Intense competition will continue to drive device manufacturers to make claims of effectiveness based on poor-quality evidence. All users have a responsibility to be well informed and to offer evidence-based advice to women.

Please cite this article as: Justin W, Ibraheim M, Bagtharia S, Haloob R. Current minimal access techniques in the treatment of heavy menstrual bleeding. The Obstetrician & Gynaecologist 2007;9:223–232.