Clinical data

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Literature review 2020

  1. Munro & al: the two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions – Int J Gynecol Obstet 2018; 1-16

The purpose of this review is to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education and clinical care. The authors review the terminologies and definitions of symptoms of abnormal uterine bleeding (FIGO-AUB system 1) and the classification of underlying causes of AUB (FIGO AUB system 2: PALM-COEIN).

FIGO AUB system 2: PALM COEIN classification of causes of AUB

Polyp Coagulopathy
Adenomyosis Ovulatory dysfunction
Leiomyoma Endometrial
Malignancy & hyperplasia Iatrogenic
  Not otherwise classified

 

  1. Magnay & al: a systematic review of methods of measure menstrual blood loss – BMC women’s health 2018 18: 142

Many approaches have been developed to assess menstrual blood loss; the aim of this systematic review is to determine for methods of measuring menstrual blood loss: ability to distinguish between normal and heavy menstrual bleeding HMB, practicalities and limitations in the research setting and suitability for diagnosing HMB in routine clinical practice. Every method to assess menstrual blood loss has limitation. Pictorial methods strike a good balance between ease of use and validated accuracy of MBL determination and could complement assessment of HMB using quality of life in the clinical and research setting.

  1. Drilewicz & al: endometrial ablation: normal appearance and complications – Abdominal Radiology 2018 vol 43: 2774-82

The increase utilization of non-resectoscopic endometrial ablation techniques translates into increased imaging of patients who have undergone the procedure.. An understanding of the expected imaging appearances of endometrial ablation using different modalities is important for the abdominal radiologist. In addition, the frequent usage of the technique naturally comes with complications requiring appropriate imaging work-up. This article review the expected appearance of the post-endometrial ablated uterus on multiple imaging modalities and demonstrate the more common and rare complications seen in the immediate post-procedural time period and remotely.

  1. Miller & al: cost-effectiveness of global endometrial ablation vs. hysterectomy for the treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives – Population Health Management 2015 vol 18: 5

The objective of this study is to model the cost-effectiveness of global endometrial ablation (GEA) vs. hysterectomy for treatment of AUB in the United States from both commercial and Medicaid payer perspectives.  Clinical and economic data (including treatment patterns, health care resource utilization, direct costs and productive costs) came from analyses of commercial and Medicaid claims databases. Analysis results show that cost savings with simultaneous reduction in treatment complications and fewer days lost from work are achieved with GEA versus hysterectomy over almost all time horizons and under both the commercial payer and Medicaid perspectives – evidence strongly supporting the clinical-economic value about GEA vs. hysterectomy.

  1. Spencer & al: cost-effectiveness of treatments for heavy menstrual bleeding – Am J Obstetrics Gynecology 2017: 217: 574 e1-9

Heavy menstrual bleeding affects up to one third of women in the United States, resulting in a reduced quality of life and significant costs to health care system. The aim of this study is to evaluate the relative cost-effectiveness of 4 treatment options for heavy menstrual bleeding: hysterectomy, resectoscopic endometrial ablation, non-resectoscopic endometrial ablation and the levonorgestrel intrauterine system. Treatments were compared in terms of total average costs, quality-adjusted life years and incremental cost-effectiveness ratios.

Nota bene: three authors of this paper are consultants for Teleflex medical and one for Olympus … conclusions should be taken with caution!

  1. Kumar & al: endometrial ablation for heavy menstrual bleeding – women’s health 2016 12/1) 42-52

Endometrial ablation has changed the management of heavy menstrual bleeding dramatically: the development of the second generation techniques has enabled clinicians to set up comprehensive “one stop clinics” based on an outpatient service to treat heavy menstrual bleeding effectively. This article describes the rationale and evidence for use of different endometrial auto-ablative systems along with relevant technical and clinical aspects. It also addresses the essentials of a successful approach to out-patient endometrial ablation along with discussion on risks, complications and contraindications on the procedure.

  1. Smith & al: bipolar radiofrequency compared with thermal balloon ablation in the office – Obstetrics & Gynecology 2014 vol 124 no 2 part 1

To estimate the effectiveness of office-based bipolar radiofrequency vs thermal balloon ablation of the endometrium for the treatment of heavy menstrual bleeding at 5-year follow-up, a single blind randomized controlled trial was conducted in an office hysteroscopic clinic in a university teaching hospital. 81 women were randomly allocated to either bipolar radiofrequency ablation or thermal balloon ablation. The primary outcome was amenorrhea rate at 6 months follow-up. The main outcome measures were amenorrhea rates, patient satisfaction, health related quality of life and incidence of further uterine surgery at 5-year follow-up. There was no significant difference in the effectiveness of bipolar radiofrequency ablation and thermal balloon ablation performed in an office setting at 6 months follow-up and at 5-years follow-up.

  1. Kalampokas & al: endometrial cancer after endometrial ablation or resection for menorrhagia – Int J Gynecol Obstet 2018: 142 84-90

The present retrospective cohort study tries to assess the incidence of endometrial cancer after endometrial ablation or resection for menorrhagia. To achieve this purpose, the study included women who underwent endometrial ablation or resection for menorrhagia at Aberdeen Royal Infirmary between February 1st 1990 and December 31, 1997. Follow-up data until 2015 were examined. To assess risk of endometrial cancer, each women was matched by age to the annual observed incidence of endometrial cancer in Northeast Scotland for each year from the date of endometrial ablation or resection until 2015. As a main conclusion, this study indicates that the risk of endometrial cancer could be significantly reduced but not eliminated by endometrial ablation or resection.

  1. Wortman & al: postablation endometrial carcinoma – J Society Laparoendoscopic Surgeon 2017 vol 21 issue 2

Many women have undergone resectoscopic or nonresectoscopic endometrial ablation for heavy menstrual bleeding during the past 20 – 30 years. These women are now approaching their sixth and seventh decade of life a time frame in which endometrial carcinoma is most frequently diagnosed. In this review, the authors describe 6 cases of post ablation endometrial cancer. The authors examine also several key questions regarding the impact of endometrial ablation on the subsequent development of endometrial carcinoma, the manner in which the post ablation endometrial cancer presents, the efficacy of traditional diagnostic modalities, the ablation-to-cancer interval and the stage of post ablation endometrial cancer at the time of diagnoses.

  1. Kohn & al: pregnancy after endometrial ablation: a systematic review – BJOG 2017

Pregnancies have been reported after endometrial ablation or resection (0.7%) and this is the most recent review about the subject. The authors have identified 274 pregnancies from 99 sources in the medical literature; they describe the outcome of these pregnancies, and the high rate of complications. As a main conclusion, this review insist that women undergoing endometrial ablation should be informed that subsequent pregnancy may have serious complications and should be counselled to use a reliable contraception after the procedure.

Outcomes of pregnancies after endometrial ablation

(n = 258)

 

 < 24 weeks   >24 weeks Aggregate
Elective termination      114      114
Miscarriage       45       45
Ectopic pregnancy       12       12
Molar pregnancy        1

        1

 
Inutero fetal demise        3           6        9
Preterm delivery        5         25      40
Fullterm delivery         31      31
Not stated        1           5        6

 

Literature review 2019

  1. Munro & al: the two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions – Int J Gynecol Obstet 2018; 1-16

The purpose of this review is to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education and clinical care. The authors review the terminologies and definitions of symptoms of abnormal uterine bleeding (FIGO-AUB system 1) and the classification of underlying causes of AUB (FIGO AUB system 2: PALM-COEIN).

FIGO AUB system 2: PALM COEIN classification of causes of AUB

Polyp Coagulopathy
Adenomyosis Ovulatory dysfunction
Leiomyoma Endometrial
Malignancy & hyperplasia Iatrogenic
  Not otherwise classified

 

  1. Magnay & al: a systematic review of methods of measure menstrual blood loss – BMC women’s health 2018 18: 142

Many approaches have been developed to assess menstrual blood loss; the aim of this systematic review is to determine for methods of measuring menstrual blood loss: ability to distinguish between normal and heavy menstrual bleeding HMB, practicalities and limitations in the research setting and suitability for diagnosing HMB in routine clinical practice. Every method to assess menstrual blood loss has limitation. Pictorial methods strike a good balance between ease of use and validated accuracy of MBL determination and could complement assessment of HMB using quality of life in the clinical and research setting.

  1. Drilewicz & al: endometrial ablation: normal appearance and complications – Abdominal Radiology 2018 vol 43: 2774-82

The increase utilization of non-resectoscopic endometrial ablation techniques translates into increased imaging of patients who have undergone the procedure.. An understanding of the expected imaging appearances of endometrial ablation using different modalities is important for the abdominal radiologist. In addition, the frequent usage of the technique naturally comes with complications requiring appropriate imaging work-up. This article review the expected appearance of the post-endometrial ablated uterus on multiple imaging modalities and demonstrate the more common and rare complications seen in the immediate post-procedural time period and remotely.

  1. Miller & al: cost-effectiveness of global endometrial ablation vs. hysterectomy for the treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives – Population Health Management 2015 vol 18: 5

The objective of this study is to model the cost-effectiveness of global endometrial ablation (GEA) vs. hysterectomy for treatment of AUB in the United States from both commercial and Medicaid payer perspectives.  Clinical and economic data (including treatment patterns, health care resource utilization, direct costs and productive costs) came from analyses of commercial and Medicaid claims databases. Analysis results show that cost savings with simultaneous reduction in treatment complications and fewer days lost from work are achieved with GEA versus hysterectomy over almost all time horizons and under both the commercial payer and Medicaid perspectives – evidence strongly supporting the clinical-economic value about GEA vs. hysterectomy.

  1. Spencer & al: cost-effectiveness of treatments for heavy menstrual bleeding – Am J Obstetrics Gynecology 2017: 217: 574 e1-9

Heavy menstrual bleeding affects up to one third of women in the United States, resulting in a reduced quality of life and significant costs to health care system. The aim of this study is to evaluate the relative cost-effectiveness of 4 treatment options for heavy menstrual bleeding: hysterectomy, resectoscopic endometrial ablation, non-resectoscopic endometrial ablation and the levonorgestrel intrauterine system. Treatments were compared in terms of total average costs, quality-adjusted life years and incremental cost-effectiveness ratios.

Nota bene: three authors of this paper are consultants for Teleflex medical and one for Olympus … conclusions should be taken with caution!

  1. Kumar & al: endometrial ablation for heavy menstrual bleeding – women’s health 2016 12/1) 42-52

Endometrial ablation has changed the management of heavy menstrual bleeding dramatically: the development of the second generation techniques has enabled clinicians to set up comprehensive “one stop clinics” based on an outpatient service to treat heavy menstrual bleeding effectively. This article describes the rationale and evidence for use of different endometrial auto-ablative systems along with relevant technical and clinical aspects. It also addresses the essentials of a successful approach to out-patient endometrial ablation along with discussion on risks, complications and contraindications on the procedure.

  1. Smith & al: bipolar radiofrequency compared with thermal balloon ablation in the office – Obstetrics & Gynecology 2014 vol 124 no 2 part 1

To estimate the effectiveness of office-based bipolar radiofrequency vs thermal balloon ablation of the endometrium for the treatment of heavy menstrual bleeding at 5-year follow-up, a single blind randomized controlled trial was conducted in an office hysteroscopic clinic in a university teaching hospital. 81 women were randomly allocated to either bipolar radiofrequency ablation or thermal balloon ablation. The primary outcome was amenorrhea rate at 6 months follow-up. The main outcome measures were amenorrhea rates, patient satisfaction, health related quality of life and incidence of further uterine surgery at 5-year follow-up. There was no significant difference in the effectiveness of bipolar radiofrequency ablation and thermal balloon ablation performed in an office setting at 6 months follow-up and at 5-years follow-up.

  1. Kalampokas & al: endometrial cancer after endometrial ablation or resection for menorrhagia – Int J Gynecol Obstet 2018: 142 84-90

The present retrospective cohort study tries to assess the incidence of endometrial cancer after endometrial ablation or resection for menorrhagia. To achieve this purpose, the study included women who underwent endometrial ablation or resection for menorrhagia at Aberdeen Royal Infirmary between February 1st 1990 and December 31, 1997. Follow-up data until 2015 were examined. To assess risk of endometrial cancer, each women was matched by age to the annual observed incidence of endometrial cancer in Northeast Scotland for each year from the date of endometrial ablation or resection until 2015. As a main conclusion, this study indicates that the risk of endometrial cancer could be significantly reduced but not eliminated by endometrial ablation or resection.

  1. Wortman & al: postablation endometrial carcinoma – J Society Laparoendoscopic Surgeon 2017 vol 21 issue 2

Many women have undergone resectoscopic or nonresectoscopic endometrial ablation for heavy menstrual bleeding during the past 20 – 30 years. These women are now approaching their sixth and seventh decade of life a time frame in which endometrial carcinoma is most frequently diagnosed. In this review, the authors describe 6 cases of post ablation endometrial cancer. The authors examine also several key questions regarding the impact of endometrial ablation on the subsequent development of endometrial carcinoma, the manner in which the post ablation endometrial cancer presents, the efficacy of traditional diagnostic modalities, the ablation-to-cancer interval and the stage of post ablation endometrial cancer at the time of diagnoses.

  1. Kohn & al: pregnancy after endometrial ablation: a systematic review – BJOG 2017

Pregnancies have been reported after endometrial ablation or resection (0.7%) and this is the most recent review about the subject. The authors have identified 274 pregnancies from 99 sources in the medical literature; they describe the outcome of these pregnancies, and the high rate of complications. As a main conclusion, this review insist that women undergoing endometrial ablation should be informed that subsequent pregnancy may have serious complications and should be counselled to use a reliable contraception after the procedure.

Outcomes of pregnancies after endometrial ablation

(n = 258)

 

 < 24 weeks   >24 weeks Aggregate
Elective termination      114      114
Miscarriage       45       45
Ectopic pregnancy       12       12
Molar pregnancy        1

        1

 
Inutero fetal demise        3           6        9
Preterm delivery        5         25      40
Fullterm delivery         31      31
Not stated        1           5        6

 

Literature review 2018

 Abnormal uterine bleeding

  1.  Abnormal uterine bleeding – Whitaker & al 2016 in best practice & research clinical obstetrics and gynecology 34 (54-65)

The authors describes a structured approach for establishing the cause of the abnormal bleeding using the FIGO PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, Not otherwise classified) classification system which facilitate accurate diagnosis and inform treatment options.

Comparative studies

  1. Hysteroscopic transcervical endometrial resection vs thermal balloon destruction for menorrhagia: a prospective randomized trial on satisfaction rate – Pellicano & al in Am J obstetrics and gynecology 2002 vol 187 no3

This is a prospective randomized trial with two years follow up comparing the satisfaction rate and the effectiveness of transcervical hysteroscopic endometrial resection and thermal destruction of the endometrium in the treatment of menorrhagia. 82 patients were randomized to resection or thermal destruction. Satisfaction rate was higher in thermal destruction, operative time and reintervention rates were higher in resection group.

  1. Cavaterm thermal balloon endometrial ablation vs hysteroscopic endometrial resection to treat menorrhagia: the French multicentre randomized study – Brun & al in J minimally invasive gynecology 2006 vol 13 (424-430)

In this multicentre prospective randomized study, 51 women with menorrhagia unresponsive to medical treatment were randomized to thermal destruction or resectoscopic resection. A 6 and 12 months postoperative evaluation was completed. Significant reduction of menstrual blood loss was observed after both techinques and satisfaction rate was high, 89% in the cavaterm group and 79% in the resection group at 12 months.

  1. Randomized controlled trial of thermal balloon ablation vs vaginal hysterectomy for leiomyoma-induced heavy menstrual bleeding – Jain & al in international J of gynecology and obstetrics 2016 vol 137 (140-144)

40 eligible women with high menstrual bleeding (HMB) were randomly allocated to undergo thermal balloon destruction or vaginal hysterectomy; the primary outcome was the number of HMB in the thermal balloon group. At 6 months after operation none of the women in the thermal destruction group had HMB. For the authors, thermal balloon destruction can replace vaginal hysterectomy in some perimenopausal women with uterine leiomyomas.

  1. Comparison of two method treatments of endometrial ablation, thermal balloon ablation (TBA) and hysteroscopic resection for patients with heavy menstrual bleeding Bouzari & al in J of medicine and health research 2017 2(2) 51-58

This Iranian study collected 108 women with history of heavy menstrual bleeding, unresponsive to hormone therapy or were not candidates for hysterectomy. The women were treated either with thermal balloon destruction or with hysteroscopic resection. Success rate after 12 months was 88% in the TBA group and 92% in the resection group. Satisfaction rate was the same in the two groups.

  1. Meta-analysis of bipolar radiofrequency endometrial ablation vs thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding Zhai & al in international J of gynecology and obstetrics 2018 vol 140 (3-10)

The objective of this study is to compare bipolar radiofrequency and thermal balloon endometrial ablation in terms of efficacy and health related quality of life; six study including 901 patients were included. Amenorrhea rate at 12 months is higher after bipolar radiofrequency but there were no differences noted in terms of dysmenorrhea or treatment failure; both techniques reduce menstrual loss and improve quality of life.

Supportive studies (one arm studies)

  1. Outcome of the first 220 cases of endometrial balloon ablation using cavaterm plus El Toukhy & al in J of obstetrics and gynecology 2004 vol 24 no 6 (680-683)

The objective of this prospective study was to evaluate the effectiveness of day-case cavaterm plus thermal balloon endometrial ablation in the treatment of menorrhagia; the study included 220 patients and the mean follow up period was 19 months. No procedure related operative or immediate postoperative complications were reported. The amenorrhea-hypomenorrhea rates ranged between 74% and 83%; at the end of the follow up, 83% of patients were satisfied with the procedure.

  1. Evaluation of the success rate of endometrial ablation by cavaterm plus technique Asgari & al in J minimally invasive surg science 2014 3(1) e12431

To evaluate the response to treatment rate of the cavaterm plus technique for management of menorrhagia, 40 women aged 35-50 with heavy menstrual bleeding underwent thermal balloon endometrial ablation and were followed for one year. The overall improvement of menorrhagia was reported 92%; the authors describe also a significant improvement of dysmenorrhea after treatment,

  1. Thermal balloon ablation for dysfunctional uterine bleeding among Iranian patients – Ashrafganjoei & al in J research in medical and dental science 2016 vol 4 issue 4

In this single arm prospective study, 52 women underwent thermal balloon endometrial ablation using cavaterm plus system; a follow up of 12 months was organised. 88% of patients responded to treatment and were satisfied with their treatment.

 Long term follow up studies

  1. Long term patient satisfaction with thermal balloon ablation for abnormal uterine bleeding – Penezic & al in J of society of laparoendoscopic surgeons 2014 vol 18 issue 3

The purpose of this study was to determine long term satisfaction after thermal balloon endometrial ablation 7 to 10 years after initial operation ; the survey response was 62%.: 87% of the respondents were satisfied with the results of their initial procedure.

  1. Probability of hysterectomy after endometrial ablation Longinotti & al in obstetrics & gynecology 2008 vol 112 no 6

This is a retrospective cohort analysis of data from Kaiser Permanente Nothern Californian members undergoing endometrial ablation between 1999 and 2004 and collected through 2007. The types of endometrial ablation were resection, radiofrequency, hydrothermal and thermal balloon. The rate of subsequent hysterectomy performed was 21% and 3.9% of women had uterine conserving procedures. Age was a significant predictor of hysterectomy. According to initial endometrial ablation procedure used, the rate of subsequent hysterectomy was 22.2% for first generation techniques, 18,5 for hydrothermal, 20.1% for radiofrequency and 13.9% for thermal balloon. Endometrial ablation for menorrhagia permits uterine conservation in more than 80% of women over age 45 when follow up to 8 years.

  1. Long-term incidence of hysterectomy following endometrial resection or endometrial ablation for heavy menstrual bleeding – Kalampokas & al in international J gynecol & obstetrics 2017; 1-4

The objective of this retrospective study is to estimate the incidence of hysterectomy following endometrial ablation or resection; 901 patients underwent endometrial ablation or resection for heavy menstrual bleeding between February 1990 and December 1997; the follow up at the end of 2015 showed that 206 (22,9%) patients underwent hysterectomy of these patients who underwent hysterectomy, 75% did so in the first five years following endometrial ablation or resection; the conclusion of this study is that a significant majority of women who underwent endometrial ablation or resection for heavy menstrual bleeding did not require hysterectomy up to 25 years after procedure.

  1. Incidence and predictors of failed second generation endometrial ablation – Klebanoff & al in gynecological survey 2017

The need for any treatment following an endometrial ablation is frequently cited as “failed therapy”; the aim of this large retrospective cohort study was to assess treatment outcomes with regard to only second generation devices and to determine the incidence and predictors of failed second generation endometrial ablation defined as the need for surgical re-intervention; 5936 women underwent endometrial ablation between october 2003 and march 2016 – of this total, 927 (15,6%) women who required re-intervention, 822(13,9%) underwent hysterectomy and 105(1,8%) repeat endometrial ablation. Age and ethnicity were significant risk factors for failed endometrial ablation.

Endometrial ablation: failures & complications

  1. Endometrial ablation: postoperative complications – Sharp in American J obstetrics and gynecology October 2012

The objective of this paper was to provide information concerning endometrial ablation or resection postoperative complications ; physicians performing this type of surgery should  be aware of postoperative complications and able to diagnose and provide treatment for these conditions; the postoperative complications discussed are the following : 1) pregnancy after endometrial ablation 2) pain-related obstructed menses 3) failure to control menses 4) risk from pre-existing conditions (endometrial neoplasia)  5) infections. 

  1. Late-onset endometrial ablation failure – etiology, treatment and prevention – Wortman & al in J minimally invasive gynecology 2014 vol 22 no 3
  2. Late-onset endometrial ablation failure – Wortman in women’s health 2017 vol 15 (11-18)

Long term follow up data after endometrial ablation or resection indicate that several types of late-onset endometrial ablation failures cause at least 25% of women undergo subsequent hysterectomy. This review summarizes the history and demographics of non resectoscopic endometrial ablation and global endometrial ablation procedures as well as the presentation of ethiology, risk factors, treatment options and prevention of these late onset failures.

  1. Endometrial ablation – Malcolm Munro in best practice & research clinical obstetrics and gynecology 2017
  2. Endometrial ablation – Abimola Famuyide in J minimally invasive gynecology 2017

These two articles reviews the spectrum of endometrial ablation techniques and devices, their clinical outcomes and adverse events and explore their value compared to hysterectomy and selected medical therapies. Regardless to the technique used, endometrial ablation reduces menstrual blood loss, improve general and menstrual-related quality of life and prevents hysterectomy in 4 of 5 women who undergo the procedure. When patients are appropriately selected, outcomes are optimized, and risks of serious complications are minimized.

  1. Endometrial resection and global ablation in the normal uterus

S.J. Leathersich & al in best practice & clinical research obstetrics and gynecology 2018

The ideal method of treating heavy menstrual periods would be safe, effective, acceptable to patients and practitioners, cost-effective. Require minimal expertise and appropriate for outpatient use. This very recent article reviews the history, rationale, evidence, indication and long-term safety and efficacy of the various methods that can be used to destroy the endometrium as a treatment for menorrhagia. It also discusses endometrial ablation in the context of its clinical utility in comparison with existing alternative treatments.

  1. Bowel perforation after global endometrial ablation – Rajwani & al in J minimally invasive gynecology 2018

This is a case report: a 42 year old woman underwent bipolar radiofrequency endometrial ablation without any integrity assessment or procedure problem; the patient was discharged soon after the end of the procedure but had to be readmitted three days later for worsening abdominal pain, vomiting and obstipation. The scan was suggestive of perforated viscus and the laparotomy showed feculent peritonitis, a distal ileal perforation and full thickness uterine perforation of the right cornua.

Pregnancy after endometrial ablation

  1. Pregnancy after endometrial ablation: English literature review and case report – Lo & al in J minimally invasive gynecology 2006 13 (88-91)
  2. Pregnancy after hysteroscopic endometrial ablation without endometrial preparation: a report of five cases and a literature review – Chang-Sen Yin in Taiwan J obs gyn 2010 vol 49 no 3
  3. Pregnancy after Novasure endometrial ablation: two cases and a literature survey Mak & al in J cases rep stud 2015 vol 3 issue 3

It is well known that endometrial ablation or resection is not contraceptive. The frequency of pregnancies after endometrial ablation or resection is around 0,7%; compared to “general population”, the rate of serious complications is high (table below); in these three articles, the authors present case reports and literature review about pregnancies after endometrial ablation; most of these pregnancies are affected by severe complications during the first trimester ( high level of spontaneous miscarriages), the last trimester (increased number of premature rupture of membranes or perinatal mortality) or during deliveries (placental adhesion, maternal mortality)

Complications

Pregnancies after ablation or resection of endometrium

General population

Spontaneous miscarriages

28%

10,9%

Premature rupture membranes

12%

0,5-8%

Prematurity

31%

5,7%

Ectopic pregnancy

6,5%

2,3%

Placental adhesion

22%

0,4%

Perinatal mortality

14%

<1%

Maternal mortality

1,6%

0,01%

                                                                                                        (Ref: Mak & al 2015)

 

The Cochrane database

  1. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding Fergusson & al 2013 – the Cochrane collaboration

The objective of this review is to compare the effectiveness, acceptability and safety of techniques of endometrial destruction by any means versus hysterectomy by any means for the treatment of heavy menstrual bleeding. The review of studies revealed that endometrial ablation/resection is an effective and possibly cheaper alternative to hysterectomy with faster recovery, although retreatment is sometimes necessary.

  1. Endometrial resection and ablation techniques for heavy menstrual bleeding – Lethaby & al 2013 – The Cochrane collaboration

The objective of this review is to compare the efficacy, safety and acceptability of endometrial destruction techniques to reduce heavy menstrual bleeding. For the authors, the endometrial ablation techniques offer a less invasive surgical alternative to hysterectomy. Second generation techniques are technically more simple and quicker to perform than first generation techniques while satisfaction rates and reduction in heavy menstrual bleeding are similar.

Klinische Daten bis 2006