From the Guidelines
Women undergoing endometrial ablation (EA) solely for convenience of amenorrhea are at risk of serious unintended consequences, including persistent or recurrent bleeding, cramping, and potential endometrial atrophy.
Risks and Considerations
- Possible long-term complications of endometrial ablation include postablation Asherman syndrome, synechiae, cervical stenosis, contracture of the endometrium, strictures, endometrial distortion, and delayed endometrial cancer diagnosis 1.
- Endometrial ablation is not a form of contraception, and large population-based linkage studies demonstrate an elevated risk of extrauterine pregnancy, preterm delivery, and stillbirth with this procedure 1.
Pre-Procedure Evaluation
Pre-procedure counseling and evaluation, including assessment of menstrual flow and symptom severity, are essential to determine suitability for the procedure, and patients should be informed of potential risks, including the need for concurrent hormone therapy, such as oral contraceptives or progesterone, to mitigate these effects.
Key Considerations
- Endometrial ablation should only be performed after failure of medical therapy 1.
- Informed consent and counseling should be provided to those women wanting the procedure, discussing the potential long-term complications and risks associated with endometrial ablation 1.
From the Research
Risks Associated with Endometrial Ablation (EA)
The risks for women undergoing endometrial ablation (EA) for convenience of amenorrhea (absence of menstruation) include:
- Complications such as uterine perforation, fluid overload, hematometra, and cervical lacerations, which are more common with resectoscopic EA 2
- Perioperative nausea/vomiting, uterine cramping, and pain, which are more common with non-resectoscopic EA 2
- Genitourinary complications, fistula, gastrointestinal complications, and infectious complications, which have been reported in some studies 3
- Thermal injury and other injuries related to surgery, which are potential risks of EA 3
Factors Increasing the Risk of Complications
The risk of complications increases with:
- A preoperative diagnosis of other than bleeding (odds ratio [OR] 2.89; 95% confidence interval [CI], 2.61-3.21; p <.001) 3
- Previous abdominal surgery (OR 1.42; 95% CI, 1.28-1.56; p <.001) 3
- American Society of Anesthesiologists score 3+ (OR 1.37; 95% CI, 1.27-1.48; p <.001) 3
Long-term Risks and Outcomes
Long-term follow-up studies have shown that:
- The cumulative reintervention rate (including both medical and surgical reinterventions) was 40.0% in the 52-mg levonorgestrel-releasing intrauterine system group and 28.7% in the radiofrequency nonresectoscopic endometrial ablation group 4
- The cumulative rate of surgical reinterventions only was significantly higher among patients with a treatment strategy starting with a 52-mg levonorgestrel-releasing intrauterine system compared with radiofrequency nonresectoscopic endometrial ablation 4
- Most reinterventions occurred during the first 24 months of follow-up 4
Safety and Efficacy of EA
EA is considered a safe and effective minimally invasive option for the treatment of abnormal uterine bleeding of benign etiology 2, 5 EA can be used as an alternative to hysterectomy in women who desire uterine preservation and have failed medical treatment 5