From the Guidelines
Elevated testosterone levels are not a contraindication to endometrial ablation in a 44-year-old woman with Abnormal Uterine Bleeding (AUB) due to a submucosal fibroid, as the primary considerations for the procedure should be the patient's symptoms, fibroid characteristics, and exclusion of endometrial hyperplasia or cancer 1. When evaluating the patient for endometrial ablation, it is crucial to consider the size and location of the fibroid, as well as the patient's symptoms, rather than the elevated testosterone level alone. The patient should undergo a thorough evaluation, including endometrial biopsy, to rule out endometrial hyperplasia or cancer before proceeding with the ablation procedure. Key considerations for the patient include:
- Understanding that ablation treats bleeding symptoms but does not remove the fibroid itself
- Recognizing that hysteroscopic myomectomy might be considered as an alternative or complementary procedure, depending on the fibroid's size and location
- Investigating the cause of the testosterone elevation separately, as it may require its own management plan. Given the information from the study on the management of uterine fibroids 1, the focus should be on the patient's symptoms, the characteristics of the fibroid, and ensuring that endometrial ablation is appropriate based on these factors, rather than the elevated testosterone level.
From the Research
Elevated Testosterone Level and Endometrial Ablation
- There is no direct evidence in the provided studies that suggests an elevated testosterone level constitutes a contraindication to endometrial ablation in a 44-year-old woman with Abnormal Uterine Bleeding (AUB) due to a submucosal fibroid 2, 3, 4, 5, 6.
- However, the studies do emphasize the importance of preoperative assessment to rule out any contraindications to endometrial ablation, including the evaluation of abnormal uterine bleeding and assessment of the uterine cavity 3.
- The presence of high-risk factors for endometrial carcinoma, such as persistent hyperplasia unresponsive to hormonal therapy, may influence the selection of a hysterectomy over endometrial ablation 5.
- Endometrial ablation is considered a safe and effective minimally invasive option for the treatment of AUB of benign etiology, but it is essential to carefully screen patients before undergoing the procedure 3, 4.
- The studies do not mention testosterone levels as a factor to consider in the management of AUB or endometrial ablation, but they do discuss the importance of evaluating and managing other risk factors for endometrial carcinoma 5.