Endometrial Ablation for Abnormal Uterine Bleeding Associated with High Risk of Hysterectomy

Endometrial ablation (EA) is a minimally invasive procedure used to treat abnormal uterine bleeding (AUB) and is often presented as an alternative to hysterectomy. While EA is generally considered safe with low complication rates, less is understood about the likelihood of patients needing further surgical intervention after the procedure. A recent study has revealed that 29% of individuals who undergo EA will eventually require a hysterectomy to remove the entire uterus within 15 years.

A research group comprising investigators from ICES (Toronto, ON, Canada) conducted an analysis of 76,446 patients over a 15-year period to investigate the need for surgical interventions after an initial EA. The study, published in Facts, Views & Vision in ObGyn, focused on patients who underwent their first EA between 2002 and 2017. The study showed that 22% of these patients required further surgical procedures following their EA. Within the first year, 5% of women proceeded to have a hysterectomy. This rate increased to 17% at five years, 23% at 10 years, and 29% at 15 years. Notably, the rate showed no signs of leveling off even at the 15-year mark. The likelihood of needing a subsequent hysterectomy was higher among younger individuals, those with more complex diagnoses, or those who had previously undergone abdominal surgeries like tubal ligation.

The high percentage of women who ultimately progressed to hysterectomy raises concerns and suggests that EA may be more effective as a short-term solution to improve symptoms, rather than a definitive treatment to prevent hysterectomy, according to the researchers. Additionally, the study found a correlation between surgeon experience and the future risk of surgery following EA. For each additional year of the surgeon's experience (with age used as a proxy), the likelihood of a hysterectomy decreased by 3%. The researchers highlight the potential benefits of combination treatments, such as intrauterine devices (IUDs) or hormone replacement therapies, which may extend the effectiveness of EA and reduce the need for further surgeries, particularly if patients approach menopause. However, they note that more research is needed to explore these treatment options further.

“These results provide valuable information to care providers, who can counsel their patients about more realistic outcomes of endometrial ablation, and the potential need for a future hysterectomy,” said lead author Dr. Jacob McGee, an adjunct scientist at ICES Western.