Pelvic Pain After Microwave Endometrial Ablation—Is Hysteroscopic Adhesiolysis Worthwhile?

Postoperative pelvic pain is a complication associated with the use of first generation endometrial ablative techniques for treatment of dysfunctional uterine bleeding. This complication usually presents a few months after surgery with a reported incidence ranging from 4.7% to 13.5%. Short-term studies have shown that microwave endometrial ablation (MEA), a second generation endometrial ablation technique, is effective in 70% to 80% of women and has low overall risk of complications. There is, however, no long-term efficacy or safety data. This retrospective, observational study assessed whether hysteroscopic adhesiolysis after MEA could avoid the need for hysterectomy or major surgery in patients with a history of pelvic pain after MEA who were at high risk of intrauterine adhesions. Among the 20 patients in the study population, 17 (85%) were found to have intrauterine adhesions at hysteroscopy that were divided. The cure rate in the group of women with no pelvic pain before the MEA procedure who received hysteroscopic adhesiolysis alone was 85.7% (6/7), whereas only 10% (1/10) of women with pain before MEA were cured with hysteroscopic adhesiolysis alone (P < 0.01). At follow-up, 45% (9/20) of patients had been cured of pain by hysteroscopic adhesiolysis and were discharged. Of the 55% (11/20) patients with lingering complaints of pain, 9 underwent hysterectomy, 1 who was found to have endometriosis at laparoscopy had a laparoscopic bilateral salpingo-oophorectomy, and 1 received mefenamic acid. No serious adverse reactions were noted with hysteroscopic adhesiolysis. These findings suggest that hysteroscopic adhesiolysis is beneficial for patients with no history of pain before the MEA procedure. As a result, hysterectomy can be avoided in such patients who in this study comprised nearly half of the study population. The small number of cases limits the study.