Ablation Procedure Effective in Stopping Heavy Menstrual Bleeding

A less invasive procedure for treating heavy menstrual bleeding (amenorrhea), called global endometrial ablation (GEA), preserves the uterus while decreasing menstrual bleeding and shortening patients' recovery time.

Researchers at the Mayo Clinic (Rochester, MN, USA) studied the medical records of approximately 816 women who underwent GEA with either a thermal balloon ablation or a radio frequency (RF) ablation device between January 1998 and December 2005; of these, 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding immediately after ablation through at least 12 months following the procedure. Treatment failure was defined as a subsequent hysterectomy or the need for reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes.

The results showed that the amenorrhea rate following GEA was 23%, and the 5-year cumulative failure rate was 16%. Predictors of amenorrhea were age 45 years or older, uterine length less than 9 cm, endometrial thickness less than 4 mm, and use of RF ablation instead of thermal balloon ablation. Predictors of treatment failure included age younger than 45 years, parity of 5 or greater, prior tubal ligation, and history of dysmenorrhea. After global endometrial ablation, 23 women (5.1%) had pelvic pain, three (0.7%) succeeded in becoming pregnant, and none had endometrial cancer. The study was published in the January 2009 issue of Obstetrics and Gynecology.

"We found that only 16% of our subjects required hysterectomy to treat excessive bleeding five years after ablation. That is nearly half of what has generally been reported in the literature to date,” said coauthor gynecologic surgeon Abimbola Famuyide, M.D., of the division of gynecologic surgery. "Optimizing preoperative patient counseling and patient selection could allow failure rates associated with GEA to further decrease.”

During GEA, surgeons use an energy source (heat, cold, and microwave or RF energy) to destroy the uterine lining (endometrium) of the uterus, leaving the other structures intact. Once the cells or the tissue that line the uterus are destroyed, scar tissue forms, and monthly menstrual flow and any accompanying pain typically decrease. The newest forms of GEA were initially thought to be equally effective compared to hysterectomy, with slightly lower complication rates and costs.

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