Predicting Endometrial Ablation Failure

Andrew M. Kaunitz, MD


December 03, 2019

This transcript has been edited for clarity.

Endometrial ablation offers an alternative to hysterectomy for women seeking treatment for heavy menstrual bleeding. Second-generation or global devices, which typically don't require hysteroscopy and can be performed in the office as well as in the operating room, represent the most common strategy for endometrial ablation in the United States. Endometrial ablation failure (defined as repeat ablation or hysterectomy) ranges from 10% to 20%.

A recent review and meta-analysis assessed failure rates for second-generation ablation. Of 10 parameters assessed, dysmenorrhea at baseline was the strongest predictor of ablation failure.

The finding that preexisting dysmenorrhea is associated with a doubling of risk for failed ablation appears clinically relevant. I agree with the authors that dysmenorrhea may reflect preexisting endometriosis or adenomyosis, conditions that can be challenging to diagnose with ultrasound. In my patients with heavy menstrual bleeding, if dysmenorrhea is present or imaging suggests adenomyosis, I counsel them about their higher risk for ablation failure and encourage placement of a progestin IUD, or I recommend a hysterectomy.

Thank you for the honor of your time. I am Andrew Kaunitz.

Andrew Kaunitz is professor and associate chairman in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville, where he makes his home.

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