Is endometrial ablation still a valid option in the management of abnormal uterine bleeding?

Abstract

History of the study of uterine cavity Although the interior of the uterus has been studied for more than two centuries by pioneers using mirrors, specula and candles, modern hysteroscopy was practiced from the early 1900’s when David described the technique, the indications and contraindications. 1 Hysteroscopy is now considered the gold standard not only for visualizing the cervical canal and uterine cavity but also for treating different benign pathological endometrial conditions. In the 1980s-1990s there were only two options for performing endometrial biopsies ‐ blind procedures (dilatation and curretage or use of endometrial suction biopsy curettes) or targeted hysteroscopic biopsies (THB). The former could not invariably confirm a definitive diagnosis and the latter still required dilatation of the cervical canal and some form of anaesthesia. Most diagnostic hysteroscopes had a lens diameter of 5mm or more but the most recent hystereoscopes are based on a 2mm rod lens system within a 4mm sheath. Hysteroscopy and endometrial biopsy is now the first-line investigation of women with abnormal uterine bleeding since it allows direct visualization of the endometrial cavity and the opportunity to obtain a directed endometrial biopsy.