Endometrial Ablation Details

While endometrial ablation is associated with high patient satisfaction rates, Up to 38% of women require followup surgery within 4-5 years of follow-up.  This has led to a shift toward Minimally invasive hysterectomy (laparoscopically performed).

  • Risk factors for treatment failure include:
    • a history of severe menstrual cramps
    • prior tubal sterilization
    • having over 5 children
    • presence of internal endometriosis (adenomyosis)
    • and age <45 years
  • Hysteroscopic sterilization should not be performed at the same time as endometrial ablation, since intrauterine scarring formed as a result of ablation may compromise the required 3-month test of tubal occlusion by HSG
COMPLICATIONS:
1) Pregnancy after endometrial ablation
2) Pain related to obstructed menses (hematometra and postablation tubal sterilization syndrome)
3) Failure to control heavy menses (requiring repeat ablation or hysterectomy)
4) Risk associated with preexisting conditions (cesarean section and endometrial hyperplasia)
5) Infection.
Pregnancy:  has been reported in 0.7% of women after endometrial ablation, even in women not having periods.  The risk of pregnancy after endometrial ablation and tubal sterilization is estimated at 1 in 50,000.
Persistent Endometrial tissue:  Good evidence confirms that some endometrial tissue persists in the vast majority of patients who have undergone endometrial ablation.
Blood Collection Inside Uterus: Occurs in 1-3% of women after endometrial ablation, and typically presents with cyclic pain; MRI during painful episodes may demonstrate the condition.
Postablation tubal sterilization syndrome: (PATSS)—characterized by cyclic cramping with or without menses—occurs in 6-7% of women after ablation. The mechanism is thought to be retrograde menstruation into the obstructed tubal stump, with resultant pain. Definitive treatment is widely considered to be hysterectomy.
85% Are initially happy:  While most women who undergo ablation will NOT achieve complete loss of menstrual flow about 85% report that they are satisfied with their results after 12 months.
Reoperation rates of 18-38%  however have been reported at 4-5 years.
Hysterectomy:  following endometrial ablation is most commonly performed for bleeding (51%), pain (28%) or both (21%).
 
CONTRAINDICATIONS:  circumstances associated with a high risk of Cancer of the uterine lining.
Patients taking tamoxifen
Patients with hereditary non-polyposis colorectal cancer
RELATIVE CONTRAINDICATIONS: those with risk factors for endometrial cancer (e.g., anovulation, obesity, diabetes, etc.) when contemplating endometrial ablation.
INFECTION:  typically presents with fever, pelvic tenderness, and discharge within 3 days of surgery and may present up to 50 days postoperatively.  The procedure may justify prophylaxis though it is not officially recommended..