Endometrial Balloon Ablation

Since the late 1980s, some gynaecologists have been removing or destroying the lining of the womb using various methods including laser, cautery, diathermy and more recently Balloon ablation.

This article concentrates on endometrial ablation, specifically the following balloon devices: Thermachoice™ and the Vestablate™.


  1. The Thermachoice™ device uses a balloon placed in the uterine cavity through the cervix. Hot water is circulated inside the balloon.
  2. The Vestablate™ balloon has metal electrodes on the surface, with thermisters in each electrode to monitor temperature. When the device is activated, radio frequency current is applied to the electrodes, and a computer controls the temperature used to destroy the endometrium.

The most common cause of continued bleeding is regrowth of the endometrium from adenomyosis (a condition in which the lining of the uterus grows into the uterine wall). (Deep adenomyosis is one of the most common causes of failure of the procedure. If deep adenomyosis is suspected, an endometrial ablation may not be the best procedure.)

Most women who have menorrhagia (abnormally heavy menstrual periods) that is not controlled by medicine, and do not have other problems that require a hysterectomy should consider endometrial ablation. The risk is low in the hands of a physician skilled in the procedure. The procedure is done on an outpatient basis, and most women are able to return to their regular activities within a few days. A small percentage of properly selected women having an ablation will eventually need a hysterectomy, but the vast majority will not.

The Thermachoice™ device is a Uterine Balloon Therapy system that broadens a woman's choice in treatment for excessive menstrual bleeding. It is a minimally invasive alternative to a hysterectomy or other surgical procedures for pre-menopausal women who are having heavy periods due to benign causes. This simple 30-minute procedure uses heat to treat the lining of the uterus (the endometrium) and requires no incision.

Following the treatment, most women can expect light to moderate periods, or possibly total elimination of periods. It can be performed as an outpatient procedure, and can be done under local or general anesthetic. Recovery is fast and many women may return to their normal activities the next day.

The device is very effective. 96% of women who have had the procedure are still happy with their results after three years. It is only an appropriate treatment for women who have no plans for pregnancy.

This Uterine Balloon Therapy System does not require hospitalization or general anesthesia. It requires only a local anesthetic (with an intravenous sedative if indicated.) However, a woman in consultation with her doctor may decide on a general anesthetic.

A soft, flexible balloon attached to a thin catheter (tube) is first inserted into the vagina, through the cervix, and placed gently into the uterus. No incision is required. The balloon is made of silicone material, which liminates the risk to latex-sensitive women.

The balloon is then inflated with a sterile fluid that causes it to expand to fit the size and shape of the uterus. The fluid is heated to 188ºF (87ºC). This temperature is maintained for 8 minutes while the lining of the uterus is treated.

Sterile fluid is circulated within the balloon for a uniform effect. When the treatment is completed, all the fluid is withdrawn from the balloon. The catheter and balloon is removed. Nothing remains in the uterus. The treated uterine lining will shed, over the next 7 to 10 days.

Most women will experience mild to severe pressure or cramping sensation, which can be very uncomfortable, (some women experience little or no pain). Contrary to what you might expect, there is usually not a strong sensation of heat during the procedure. And, unlike alternative procedures, most women can return to their normal routines within a few days.

Within three months of the procedure, most women can expect to return to light or moderate periods, or in some cases, no bleeding. Since an endometrial ablation destroys the lining of the uterus, the procedure is not for anyone who desires to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments.