Who Will Suffer From Postablation Pelvic Pain? A Retrospective Analysis of Risk Factors [7Q

Abstract

INTRODUCTION: Identifying risk factors for post ablation pain is a critically important task. Data on individual predictors of postablation pain are mixed and conflicting. Our objective was to identify various patient characteristics associated with development of new onset or worsening pelvic pain after endometrial ablation. METHODS: A retrospective cohort study of all patients who underwent endometrial ablation at Henry Ford Health System, during 2012–2014. Baseline characteristics at the time of ablation, relevant medical comorbidities, and ablation technique and treatment outcome were analyzed. RESULTS: A total of 368 women met the inclusion criteria for the study. Sixteen percent experienced new or worsening pelvic pain after ablation; 40% of them required a hysterectomy for intractable pain. Only two factors that emerged as potential contributor to postablation pain were history of tubal ligation (adjusted odds ratio [OR] 2.34, 95% confidence interval [CI] 1.21–4.63) and prior pelvic pain (adjusted OR 7.81, 95% CI 2.97–20.98). Age, BMI, prior cesarean sections, endometriosis, preablation dysmenorrhea, presence of uterine fibroid and presumptive diagnosis of adenomyosis were not associated with the development of postablation pain. Ablation technique did not affect the rate of post ablation pain. Patients with postablation pain underwent a hysterectomy within a shorter time than those without pain (P<.001). CONCLUSION: Patient selection for endometrial ablation is crucial. Physicians should counsel women with history of tubal ligation and chronic pelvic pain about the potential for post procedure pain and subsequent treatment failure.