I am 40 and have always had very severe bleeding with my periods. I've had two children, and now my tubes are tied. My doctor suggested birth control pills to help with the bleeding, but I cannot take them. Now she wants to perform a balloon endometrial ablation. I cannot find any literature on the procedure. What does it involve? What are the risks? Thanks for any help.

--Traci

An endometrial ablation involves dilating the cervix, inserting a hysteroscope (a telescope-like instrument) into the uterine cavity, and then applying a source of energy to the uterine lining in order to destroy it. In the case of a balloon ablation, the energy source is superheated fluid; hot fluid is circulated through a balloon that has been placed in the uterine cavity. This heat destroys the uterine lining. Once there is no uterine lining, there is nothing to shed and, hence, there is no bleeding.

The balloon technique is just the newest way of ablating, or destroying, the uterine lining. Other methods use laser or electricity to accomplish the same end. Some of the advantages of the balloon technique are that the cervix does not have to be dilated very much; the balloon conforms to the shape of the uterine cavity, so that more of the lining is destroyed; and the procedure is very easy and relatively safe. Any time the uterus is instrumented, there is a risk of perforating the uterus and damaging structures that lie inside the abdominal cavity. But this risk is fairly low with a balloon ablation.

All forms of endometrial ablation, including balloon ablation, are done on an outpatient basis. The balloon ablation may be performed using only a cervical block for anesthesia, and sometimes it is done in a properly equipped doctor's office. Most other ways of performing an endometrial ablation are done in a surgery center or hospital and require either regional (spinal or epidural) or general anesthesia (which puts you to sleep). In any event, one usually goes home a few hours after the procedure is complete.

An endometrial ablation can be an excellent option to control abnormal uterine bleeding. In 80 percent of cases, bleeding diminishes substantially or even stops altogether; 20 percent of women will need additional treatment in the form of a repeat ablation or a hysterectomy to control their symptoms. The balloon technique further simplifies a procedure designed to control symptoms in the least invasive manner.