levonorgestrel intrauterine devicenoninvasive surgical technique useful for women with no intrauterine pathology
: in ablation entire endometrium along with superficial 4-6 mm of myometrium is destroyed.
To increase success rate endometrial thinning is beneficial so the procedure is planed in postmenstrual phase. GnRH analogue and danazole may be given preoperatively to achieve endometrial thinning
Divided into two group
First generation: require visulisation of endometrial cavity by hystroscope. Like in transecervical resection of endometrium [T.C.R.E.] laser ablation,roller ball ablation, bipolar vaporizing electrode.these procrdure require specialized training& costly instrumentation.
Second generation: do not require hysteroscopic visulisation.like in thermal ballon ablation, microwave ablation, hydrothermal ablation. Such procedure are simple require less operating time, done under L.A.less costly and are comparable to hystroscopic ablation in terms of reduction of bleeding and patients satisfaction.
: premalignent and malignant condition of uterus,cervix and adnaxae must be excluded by a.
b. pap’s smear
c.endocervical& endometrial sampling with or without hysteroscopy
e.colposcopy : if required
contraindication to ablation
uterine size more than 12 cm
pregnancy related complication
: 80-90%-----reduction in menstrual blood loss
70-80%-----reduction in dysmenorrhoea
80% patients require no surgical treatment upto 5 years
levonorgestrel intrauterine device: [mirena] reduces blood loss by 80%.better than thermal ablation as it also provide contraceptive benifit