Incidence of Upper Genital Tract Occlusion Following Microwave Endometrial Ablation (MEA???)

Abstract

The procedure of microwave endometrial ablation (MEA) has proven effective in women with treatment-resistant menorrhagia. Although it is assumed that pregnancy in a post-MEA uterus would be unsafe, it is not clear whether pregnancy is possible after successful MEA. This retrospective study initially enrolled 24 women having hysterosalpingography (HSG) 3 months to 2 years after MEA in an attempt to determine how often the upper genital tract is occluded after the procedure. When encouraging results were obtained, 11 more women were offered interval HSG 3 months after MEA. The 35 participants had a mean age of 41 years and a mean uterine cavity length of 86 mm (range, 65-110 mm). MEA took 2 to 7 minutes to complete, the average being just under 4 minutes. Upper genital tract occlusion was considered to be present when no radioopaque contrast medium was present beyond the internal tubal ostium. Thirty patients, 86% of the total, had upper tract occlusion, whereas the remaining 5 had incomplete occlusion with persistent tubal patency on one or both sides. All but 2 of 16 women having MEA under local anesthesia had complete occlusion. Complete occlusion was achieved in all women who were amenorrheic after MEA. Occlusion failed in one woman with minor distortion of the uterine cavity by a fibroid and in one whose cavity was 110 mm long. Women having MEA tend to be at the end of their reproductive years. The treatment causes significant uterine scarring, and if HSG affirms that the upper tract is occluded, they may appreciate being able to discontinue contraceptive measures. HSG should, however, be routinely done before taking this step. With this precaution, women may obtain relief from menstrual disorder and also end their need for contraception by undergoing MEA as a simple outpatient procedure under local anesthesia.