Endometrial Ablation vs Hysterectomy

Endometrial ablation treats the inner lining of the uterus through an instrument passed via the vagina and cervix. Hysterectomy is an operation to remove the uterus; the route may be through the vagina, keyhole surgery or an abdominal incision depending on the circumstances. Ablation aims to reduce bleeding while leaving the uterus in place. Hysterectomy is a definitive change to uterine anatomy and ends menstruation.

Endometrial ablation treats the womb lining, while hysterectomy removes the uterus and ends the ability to become pregnant.

Ablation may be considered when heavy bleeding is the central concern, the uterine cavity is suitable, and future pregnancy is not wanted. It can be less extensive than removing the uterus, but it does not remove fibroids outside the cavity or treat every cause of pelvic pain. Bleeding may lessen rather than stop, and further care can be needed if symptoms persist.

Hysterectomy may be discussed when bleeding is severe or persistent, when a uterine condition needs removal of the uterus, or when other treatments have not provided acceptable relief. It can address the uterus itself, but it is major surgery and the recovery is usually more involved. Whether the cervix, fallopian tubes or ovaries are also removed depends on the clinical reason and the surgical plan.

Ablation can cause cramping, discharge and temporary bleeding, and it may not control symptoms caused by problems outside the treated lining. Hysterectomy carries surgical risks such as bleeding, infection, blood clots and injury to nearby organs, with recovery affected by the operation route. Both choices require a discussion of anaesthesia, follow-up and warning symptoms. Pregnancy must be excluded before ablation and is not possible after hysterectomy.

Neither operation should be selected before the cause of bleeding is assessed. Medicines, a hormonal coil, removal of a cavity polyp or fibroid, uterine artery treatment, or sampling may be appropriate alternatives. New bleeding after menopause, bleeding after sex, worsening pain, fever or dizziness needs medical assessment because the priority is finding the cause and treating it safely.

The discussion includes the bleeding pattern, scans and examination findings, uterine size and shape, pain, anaemia symptoms, previous treatments, pregnancy wishes and willingness to accept major surgery. Ask whether the proposed option treats the suspected cause, what recovery at home involves, and which symptoms should trigger review. Read more about [Endometrial Ablation](/treatments/gynaecological-surgery/endometrial-ablation/) and [Hysterectomy](/treatments/gynaecological-surgery/hysterectomy/).