REVIEW ARTICLE Thermal balloon endometrial ablation: a systematic review C. Iavazzo Æ N. Salakos Æ K. Bakalianou Æ N. Vitoratos Æ G. Vorgias Æ A. Liapis Received: 26 April 2007 / Accepted: 13 August 2007 / Published online: 6 September 2007 Ó Springer-Verlag 2007 Abstract Objective The aim of our study is to review the role of thermal balloon endometrial ablation (TBEA) as an alter- native in treating abnormal uterine bleeding. Methods Articles relevant to our review and relevant references from the initially identified articles on the field that were archived by May 2007, were retrieved from Pubmed. Results Success rates ranged from 83 up to 94%, with patient’s satisfaction ranging from 57 up to 94%. Persisted menorrhagia could reach 17% in some studies. Conclusion TBEA is an effective alternative method used in the treatment of menorrhagea which results in a signif- icant reduction in menstrual bleeding and high satisfaction rates. However, a longer follow-up is required to determine the role of such a treatment. Keywords Thermal balloon endometrial ablation (TBEA) Á Metrorrhagia Á Dysfunctional uterine bleeding Introduction Menorrhagia (or excessive menstrual bleeding) is defined as the monthly blood loss of over 80 ml. It affects more than 22% [45] of premenopausal women and is responsible for one-third of the hysterectomies performed in the western world [46]. Often this disorder occurs duringperimenopause with the characteristic dysfunctional uterine bleeding. Such women are treated with medical regimens such as gonadotrophin-releasing hormone agonists, progestogens or combined oral contraceptives. Patients without sufficient relief by medical therapy are then treated with minimally invasive surgical methods. There are many surgical options for the treatment of excessive uterine blood loss such as the levonorgestrel releasing intrauterine system, the therapeutic dilatation and curettage, the rollerball electrocoagulation, Nd–YAG laser and microwaves. Furthermore, the most traditional option for non-responders to medical treatment is hysterectomy. Another alternative is Thermal Balloon Endometrial Ablation (TBEA). This method was invented 13 years ago and the first clinical trials were reported by Neuwirth et al. [47]. TBEA was designed to be used for patients with dysfunctional uterine bleeding unresponsive to medical therapy. It is used as the main alternative method to hys- terectomy in the treatment of chronic abnormal uterine bleeding presenting either in the form of menorrhagia or as a dysfunctional uterine bleeding: especially when the appropriate medical treatments fail. TBEA is a minimally invasive non-hysteroscopic tech- nique, which combines heat and pressure within the uterine cavity to destroy endometrium and part of the myometri- um. A flexible balloon attached to a catheter is placed into the uterus. The balloon is then inflated up to pressure 160–180 mm Hg with a sterile fluid, which is heated up to C. Iavazzo Á G. Vorgias Department of Gynecology, METAXA Cancer Hospital, Piraeus, Greece N. Salakos Á K. Bakalianou Á N. Vitoratos Á A. Liapis Family Planning Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece N. Salakos Á K. Bakalianou Á N. Vitoratos Á A. Liapis 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece C. Iavazzo (&) 38, Seizani Str, Nea Ionia, Athens 14231, Greece e-mail: christosiavazzo@hotmail.com 123 Arch Gynecol Obstet (2008) 277:99–108 DOI 10.1007/s00404-007-0449-7