2 The procedure

2.1 Indications

2.1.1 Photodynamic endometrial ablation is used to treat heavy menstrual periods, also known as menorrhagia.

2.1.2 Menorrhagia is a very common problem. Hysterectomy has been the standard treatment for women with menorrhagia who have not responded to medical therapy. Minimally invasive procedures used to destroy the lining of the uterus (the endometrium) are alternatives to hysterectomy. They include using lasers, radiofrequency waves, electrocautery, microwaves, heated saline or a heated balloon. Photodynamic endometrial ablation is one of these minimally invasive procedures.

2.2 Outline of the procedure

2.2.1 Photodynamic endometrial ablation involves injecting a photosensitive chemical into the uterine cavity through a hysterosalpingography catheter. A probe inserted through the cervix uses a laser to activate the photosensitive chemical, which destroys the endometrium. It can often be carried out under local anaesthetic on a day-case basis.

2.3 Efficacy

2.3.1 The evidence relating to this procedure was extremely limited and was based on one very small case series that included two women with menorrhagia and one woman with prolonged postmenopausal bleeding. For more details, refer to the Sources of evidence section.

2.3.2 The Specialist Advisors considered photodynamic endometrial ablation to be an experimental procedure not yet ready for routine clinical use.

2.4 Safety

2.4.1 The evidence considered by the Advisory Committee was limited – the single study offered no assessment of pain or discomfort during the operation. For more details, refer to the Sources of evidence section.

2.4.2 The Specialist Advisors noted that the photosensitive chemical used in the procedure may cause skin photosensitivity. They commented that the evidence available was too limited to allow accurate assessment of the safety of the procedure.