Failed Endometrial Ablation

INTRODUCTION: About 20% of women who undergo endometrial ablation subsequently undergo hysterectomy. Thus, the identification of factors that increase the risk of endometrial ablation failures would be valuable in counseling patients. Through limited chart reviews, a few factors have been identified. We searched for additional risk factors by an intense abstraction of the medical record. METHODS: A review was conducted on patients who underwent hysterectomy for failed endometrial ablation. In addition, a review of randomly selected cases of successful endometrial ablation for the same period was performed. Body mass index (BMI, calculated as weight (kg)/[height (m)]2), post–endometrial ablation weight gain, gravity, parity, cesarean delivery, comorbidities, smoking, gynecologic surgery, hysteroscopy or dilation and curettage (D&C) at the time of endometrial ablation, uterine sound length, and preoperative endometrial biopsy result were compared in separate univariate analyses. To correct for multiple measurements, all comparisons were considered significantly different if P<.002. RESULTS: During a 10-year period, endometrial ablation was performed in 785 patients, with 202 undergoing subsequent hysterectomy; 271 patients of the remaining 583 were used as a control group. All of the following were significant risk factors: smoking, multiparty, history of cesarean delivery, previous gynecologic surgery, larger uterine sound length, and lack of hysteroscopy or D&C at the time of endometrial ablation. The following factors did not appear significant: BMI, post–endometrial ablation weight gain, and preoperative endometrial biopsy pathology. Of note, 62% of patients had adenomyosis on uterine pathology. CONCLUSION: From our detailed chart review, we have identified several previously unrecognized factors that increase the risk of endometrial ablation failure. Further study of these factors may help in the counseling of patients regarding treatment options for their abnormal uterine bleeding.