Pelvic pain following microwave endometrial ablation—is hysteroscopic adhesiolysis worthwhile?

Abstract

A proportion of patients present with chronic pelvic pain following microwave endometrial ablation, presumed to be due to the development of a haematometra. This retrospective observational study of 20 patients was performed to determine if hysteroscopy and adhesiolysis is beneficial in this group of patients. Seventeen patients were found to have intrauterine adhesions at hysteroscopy that were divided. At follow-up, nine patients were cured of pain and discharged. Of the remaining 11 patients, one patient with endometriosis underwent laparoscopic bilateral salpingo-oophorectomy. Nine patients underwent hysterectomy and one patient was put on mefenamic acid. In conclusion, some patients were still symptomatic following hysteroscopy and needed further intervention in the form of major gynaecological surgery. However, 45% of patients improved following only the minor day case procedure, without needing to resort to a hysterectomy with its inherent risks and costs.