Endometrial Ablation—Current Evidence for Patient Optimization and Long-Term Outcomes

Endometrial cancer after endometrial ablation: a systematic review

“…Moreover, there are questions on the accessibility of the uterine cavity after treatment with endometrial ablation due to the presence of intrauterine adhesions, resulting in difficult endometrial sampling 9 12 37. However, the results of this review do not confirm a reduced success rate of endometrial sampling, as 89% of the cases were diagnosed with endometrial sampling using pipelle and/or hysteroscopic biopsies.…”

“…An extensive search of the literature was performed to detect all reported cases on endometrial cancer in patients who were treated with endometrial ablation for the indication of heavy menstrual bleeding. The latest review on this subject of Bardawil et al12 found 37 cases, including six cases of patients treated with endometrial ablation as treatment for post-menopausal bleeding, four cases of patients diagnosed with endometrial cancer at the time of ablation, and two cases that did not contain any clinical information. We have excluded those cases in this review and thus found 13 new cases, providing a more representative impression of the cohort patients with endometrial carcinoma after ablation.…”

“…Generally, when the total endometrium thickness is more than 3 to 4 mm or the endometrial profile is of irregular aspect, the Royal College of Obstetricians and Gynecologists guideline recommends endometrium sampling to examine the microscopic aspect of the endometrium 8–10. It is unclear whether a previously performed endometrial ablation has a negative effect on the diagnostic work-up of endometrial cancer as literature on the correlation between endometrial cancer after ablation is limited 11 12. A potential problem could be the decrease in sensitivity of ultrasound features after ablation because of changes in the endometrium and difficulties in recognition of the endometrial thickness.…”

Therapeutic options for the management of abnormal uterine bleeding

“…Endometrial ablation has been discussed earlier, and it should be remembered that it is an alternative to hysterectomy in women who no longer wish to conceive—the surgical goal is the destruction of the endometrium. When performed by a range of techniques, endometrial ablation is associated with an 80%–97% reduction in blood loss and rates of amenorrhea at 12 months that range from 15%–72% 129 . However, 17%–25% of women will undergo a hysterectomy or repeat ablation following the initial procedure, 129 with the majority occurring in the first 2–5 years after endometrial ablation 129,130 .…”

“…When performed by a range of techniques, endometrial ablation is associated with an 80%–97% reduction in blood loss and rates of amenorrhea at 12 months that range from 15%–72% 129 . However, 17%–25% of women will undergo a hysterectomy or repeat ablation following the initial procedure, 129 with the majority occurring in the first 2–5 years after endometrial ablation 129,130 . Despite endometrial ablation being contraindicated in women wishing to conceive in the future, the frequent preservation of some endometrium makes pregnancy a possibility, therefore patients still need effective contraception.…”