# Endometrial Ablation and Resection

> Endometrial ablation and resection for NEET-PG Obstetrics and Gynaecology covering methods, patient selection, contraindications and complications.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/endometrial-ablation-and-resection
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Shaw's Textbook of Gynaecology; Williams Gynecology
- How to cite: "Endometrial Ablation and Resection", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/endometrial-ablation-and-resection

## Direct answer
Endometrial ablation and resection destroy or remove the endometrial lining to treat heavy menstrual bleeding when medical therapy has failed and the uterine cavity is normal. Resection, such as transcervical resection of the endometrium, removes tissue mechanically with an electrosurgical loop, while ablation uses energy such as radiofrequency or a heated balloon to destroy it. Both are contraindicated in pregnancy, suspected endometrial cancer and a desire for future fertility.

## What you must remember
- **Indication:** Heavy menstrual bleeding with a normal uterine cavity, after medical options have failed or been declined.
- **Contraindications:** Pregnancy, a wish for future fertility, endometrial hyperplasia with atypia or cancer, and active pelvic infection.
- **Pre-procedure:** Endometrial biopsy and ultrasound exclude hyperplasia, cancer and large submucous fibroids.
- **Ablation methods:** Radiofrequency, thermal balloon, microwave and cryoablation, all of which destroy the endometrium.
- **Resection method:** Transcervical resection of the endometrium, performed with a loop under hysteroscopic vision.
- **Outcome:** Most women report reduced bleeding and many reach amenorrhoea, although results vary.
- **Complications:** Uterine perforation, haemorrhage, burns, and fluid overload with hyponatraemia when non-isotonic fluids are used.
- **Post-ablation tubal sterilisation syndrome:** Cyclical pain from haematometra in women whose tubes are occluded.

## Choosing a method for a suitable woman
A 44-year-old has heavy bleeding, a normal cavity on ultrasound and completed family size, and is considered for a minimally invasive option. The table compares the common methods, which differ in energy and in the fluid they need.

| Method | Energy or tool | Key point |
|---|---|---|
| Transcervical resection | Electrosurgical loop | Mechanical removal; monopolar systems need non-conductive fluid |
| Radiofrequency ablation | Radiofrequency energy | Short procedure; depends on cavity size and shape |
| Thermal balloon | Heated fluid in a balloon | Balloon conforms to the cavity |
| Microwave ablation | Microwave energy | Fast; cavity assessment is essential |
| Cryoablation | Freezing probe | Less commonly used |

The choice depends on uterine cavity size and shape, surgeon training and the setting. Cavity measurement and exclusion of fibroids remain essential before any method.

Operator experience matters, since outcomes and complication rates depend on careful technique and cavity control. Women are counselled that some bleeding and discharge are expected for several weeks after the procedure.

## Where the exam tries to catch you
The exam tests selection and complications, not the energy source.

- **Trap:** Offering ablation to a woman who still wants pregnancy — **Correct:** Ablation is contraindicated when future fertility is wanted, and pregnancy after ablation is a serious risk, so contraception is advised.
- **Trap:** Skipping endometrial biopsy before ablation — **Correct:** Hyperplasia or cancer must be excluded first, because ablation would otherwise hide the disease.
- **Trap:** Using normal saline in monopolar resection — **Correct:** Monopolar resection needs a non-conductive fluid such as glycine, while saline is used with bipolar systems.

## Frequently asked questions

### Who is a suitable candidate for endometrial ablation?
A suitable candidate is a woman with heavy menstrual bleeding and a normal uterine cavity who has failed medical therapy and does not want future pregnancy. Endometrial biopsy and imaging must exclude hyperplasia, cancer and large fibroids first. Surgeons also check whether the uterine size suits the chosen method.

### Which conditions contraindicate endometrial ablation?
Endometrial ablation is contraindicated in pregnancy, in women who wish to conceive, in endometrial hyperplasia with atypia or cancer, and in active pelvic infection. Large submucous fibroids and distorted cavities also make ablation unsuitable.

### What is post-ablation tubal sterilisation syndrome?
Post-ablation tubal sterilisation syndrome is cyclical pelvic pain caused by blood collecting in the uterus after ablation, in women whose tubes are occluded. The name reflects the combined effect of tubal occlusion and endometrial destruction. Treatment is usually drainage or surgery if symptoms are severe.

### Which fluid is used in monopolar transcervical resection?
Monopolar transcervical resection uses a non-conductive, non-electrolyte fluid such as glycine or sorbitol. Saline is not used with monopolar systems because it conducts current. Fluid absorption is monitored because of the risk of hyponatraemia and fluid overload.

### What are the main complications of endometrial ablation?
The main complications of endometrial ablation include uterine perforation, haemorrhage, burns, and fluid overload with hyponatraemia during resection. Infection and haematometra can also occur after the procedure. Contraception counselling is essential because pregnancy remains possible after ablation.