Hysteroscopy and heavy menstrual bleeding (to cover TCRE and second-generation endometrial ablation)

• Second-generation ablation should be favoured over first-generation endometrial ablation.
• Patient satisfaction is high after second-generation endometrial ablation.
• Younger age and preoperative dysmenorrhoea are the most important prognostic parameters for the failure of endometrial ablation.

Endometrial resection and ablation are an intermediate treatment for heavy menstrual bleeding (HMB). Many women do not like the continuous use of hormones, nor do they prefer a rigorous treatment as hysterectomy. The first generation of endometrial resection/ablation is now superseded by the second-generation endometrial ablation.Both seem to be equally effective in reducing HMB, and there was no evidence that rates of satisfaction differed significantly. Overall, second-generation techniques were often easier to perform with shorter surgery times and the ability to use local rather than general anaesthesia. Complications seem to be less after second-generation endometrial ablation; however, the easiness of use can be a pitfall.Prognostic parameters should be taken into account while counselling women who opt for an endometrial ablation. The most important prognostic parameters are age (satisfaction increases with age) and preoperative dysmenorrhoea (decreases satisfaction).