What are the potential side effects of uterine ablation?

Side Effects of Uterine Ablation

Uterine ablation carries significant potential side effects including post-ablation syndrome, chronic pelvic pain, treatment failure requiring hysterectomy, and pregnancy complications, making it important to carefully select appropriate candidates and consider alternative treatments when possible. 1, 2

Common Side Effects

Uterine (endometrial) ablation can lead to several immediate and long-term complications:

Short-term Complications

• Perioperative discomfort:

  • Uterine cramping and pelvic pain 1
  • Nausea and vomiting (more common with non-resectoscopic techniques) 3
  • Vaginal discharge 1

• Procedure-specific complications:

  • Uterine perforation (more common with resectoscopic techniques) 3
  • Fluid overload syndrome (with resectoscopic techniques) 3
  • Cervical lacerations 3
  • Infection 4

Long-term Complications

• Post-ablation syndrome:

  • Cyclic pelvic pain due to trapped blood behind intrauterine scarring 5
  • Central hematometra (trapped blood in the uterine cavity) 5
  • Cornual hematometra (trapped blood in the uterine corners) 5
  • Post-ablation tubal sterilization syndrome (particularly in women with prior tubal ligation) 5

• Treatment failure:

  • Continued abnormal bleeding requiring reintervention 1, 6
  • High reintervention rates (up to 35% at 10 years requiring hysterectomy) 1

• Pregnancy-related complications:

  • Increased risk of extrauterine pregnancy 3
  • Higher rates of preterm delivery 3
  • Increased risk of stillbirth 3
  • Note: Endometrial ablation is not a form of contraception 1, 3

• Diagnostic challenges:

  • Potential delay in diagnosis of endometrial cancer due to scarring 5
  • Difficulty evaluating the endometrium after ablation 6

Risk Factors for Complications

Certain factors increase the risk of complications:

• Prior tubal ligation (increases risk of post-ablation syndrome) 6, 5
• Pre-existing dysmenorrhea 6
• Adenomyosis (associated with treatment failure) 1
• Uterine fibroids (especially submucosal) 1
• Uterine anomalies 3

Prevention and Management

To minimize complications:

• Proper patient selection:

  • Avoid in women desiring future fertility 3
  • Consider alternative treatments in women with prior tubal ligation 6
  • Screen for contraindications including pregnancy, endometrial hyperplasia/cancer, and active infection 3

• Procedural considerations:

  • For resectoscopic ablation, follow strict fluid monitoring protocols 3
  • Consider endometrial preparation to facilitate the procedure 3

• Alternative treatments:

  • Levonorgestrel intrauterine device is a cost-effective alternative with higher quality of life and fewer complications 6
  • Uterine artery embolization for patients with fibroids 1, 2
  • MR-guided focused ultrasound for patients concerned about post-procedure pain 1, 2
  • Hysterectomy for definitive treatment in women not desiring future fertility 1, 2

Treatment of Complications

• For post-ablation syndrome: surgical management of scarring or hysterectomy may be required 5
• For hematometra: drainage procedures or hysterectomy 5
• For continued bleeding: repeat ablation (with increased risk of complications) or hysterectomy 1, 3

Uterine ablation should be considered only after failure of medical therapy and with appropriate counseling about the significant risk of long-term complications and potential need for future hysterectomy 6.