Endometrial Ablation For Treatment Research Articles

Radiofrequency Endometrial Ablation in Patients With a History of Low Transverse Cesarean Delivery

Study ObjectiveTo assess adverse events associated with radiofrequency endometrial ablation in treatment of heavy menstrual bleeding in patients with a history of low transverse cesarean delivery (C-section group) and patients who delivered vaginally (vaginal delivery group). DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingCommunity-based gynecology practice in the United States. PatientsThe study included 194 patients (100 in the C-section group and 94 in the vaginal delivery group), aged 21 to 55 years, with a history of heavy menstrual bleeding. InterventionsNovaSure endometrial ablation procedures were performed from April 2004 through December 2010. Measurements and Main ResultsDemographic characteristics, gynecologic and pregnancy history, and procedure setting were compared between groups. Intraoperative and postoperative adverse events that occurred within 72 hours of the procedure were summarized. The C-section and vaginal delivery groups were similar for demographic characteristics with the exception of age (mean [SD], 40.6 [5.0] years vs 42.5 [5.3] years, respectively; p = .01). Parity was significantly higher in the C-section group compared with the vaginal delivery group (2.4 [0.9] vs 2.1 [0.7]; p = .006). Adverse events commonly associated with endometrial ablation occurred in 3 patients in the C-section group and 5 patients in the vaginal delivery group (p = .68). In addition, 1 patient failed the pre-ablation cavity integrity assessment; therefore, ablation was not performed. All events resolved without sequelae. No uterine perforation or bowel or bladder injury occurred in any patient. ConclusionRadiofrequency endometrial ablation performed in a community practice was well tolerated in patients with a history of low transverse cesarean delivery.

First- Versus Second-Generation Endometrial Ablation for Treatment of Menorrhagia: A Health Technology Assessment

First- Versus Second-Generation Endometrial Ablation for Treatment of Menorrhagia: A Health Technology Assessment

Long-term effect on radiofrequency heat-coagulation endometrial ablation in the treatment of anovulatory dysfunctional uterine bleeding

To investigate long-term effect on radiofrequency heat-coagulation (RF) endometrial ablation in treatment of anovulatory dysfunctional uterine bleeding (DUB). From Jul. 2001 to Nov. 2009, 1196 patients with DUB who were failed by medical treatment (including 127 patients with dysmenorrheal) were enrolled into this study in Jinan Millitary General Hospital. Those patients were divided into two groups according to age: 427 patients at age of or more than 45 years (average age 48 years) in Group A who were treated by RF procedure for amenorrhea;769 patients at age of less than 45 years old (average 37 years) in group B were treated by RF for controlling excessive menstrual bleeding. All the patients had the results of menstrual score (pictorial blood loss assessment chart, PBAC), hemoglobin (Hb), endometrial curettage pathology and hysteroscopy examination immediately after RF procedure; Some patients still had another endometrial curettage pathology and clinical results in 6 months after RF. The mean follow-up time was 72 months (range: 6 to 100 months). The evaluation criterion for RF treatment was to use optimal and significant effect measurements. For group A, the optimal treatment effect (cure) was defined as bleeding cessation and achieving amenorrhea that continued for more than 12 months after treatment. For group B, the optimal treatment effect(cure) was also defined as bleeding cessation and resuming normal menstruation which continued for more than 12 months after treatment. Significant treatment effect was defined as irregular, minor bleeding, but PBAC score less than 100 within 12 months. If patient symptoms and PBAC scores did not change compared with those before treatment, the treatment was defined as failure. For dysmenorrhea, the optimal treatment effect was disappearance for more than 12 months, the significant treatment effect was remission, and treatment failure was not changed from the pre-treatment baseline. The effective rate was the sum of that of the optimal and significant effect. One hundred and twenty-five patients with DUB treated by agents at the same time were chosen as control group. (1) The recent and long-term effective rates for bleeding cessation by RF:the total recent effective rates within 1 months were 94.82% (1134/1196), including 96.5% (412/427) in group A and 93.9% (722/769) in group B. The total curative rates for dysmenorrheal were 82.7% (105/127), including 86.4% (38/44) in group A and 80.7% (67/83) in group B. Pathology examination after hysteroscopy immediately after RF showed a completely and whole destroyed endometrium in group A, and a little rested endometrium in group B. The long-term effect rates for bleeding cessation by RF after 12, 24 and 36 months were 92.55% (969/1047), 93.9% (866/922) and 93.7% (609/650), respectively. PBAC and Hb in group A and group B within 12, 24, 36 and more than 36 months were improved significantly (P < 0.05). (2) COMPLICATIONS: the major complication was irregular minor bleeding in 1 to 2 months after treatment, the rate was 8.03% (96/1196). The second one was menorrhea in 3 months after RF, the rate was 5.18% (62/1196). This condition was corrected by the second RF. No hysterectomy was performed on those patients. RF is the safe, efficient and minimal invasive procedure in treatment for DUB. The mechanism of keeping long-term curative effect and preventing recurrence is due to endometrium inactivation and fibrosis by thermocoagulation.

Clinical analysis on long term effect of microwave endometrial ablation in treatment of menorrhagia.

To evaluate long term effect and related factors in patients with menorrhagia treated by microwave endometrial ablation (MEA). Total of 334 women with menorrhagia were treated by MEA, the range of age was from 29 to 59 years old. Among them, 59 cases were complicated by adenomyosis. All the patients were followed up on the change of menstrual cycle, the amount of flow, improvement of anaemia and complication. Fifty-three women underwent outpatient diagnostic hysteroscopy, the biopsy tissue was taken from the endometrium for histopathological examination. The mean duration of follow-up was 64.7 months (3 - 96 months). The overall curative rate was 91.3% (305/334), of which amenorrhea rate was 49.7% (166/334), menstruation reduction rate was 41.6% (139/334) ; 71.1% (140/197) of the cases who previously had dysmenorrhea had relieved their pelvic pain and the satisfactory rate was 91.9% (307/334). Among patients > 40 years, 92.9% (196/211) of operation effective rate, 93.8% (198/211) of satisfactory rate and 64.9% (137/211) of amenorrhea rate were obtained, while patients </= 40 years, 88.6% (109/123) of operation effective rate, 88.6% (109/123) of satisfactory rate and 23.6% (29/123) of amenorrhea rate were obtained. There was significant difference in rate of operation effectiveness, satisfaction and amenorrhea (P < 0.05). Forty-two cases required subsequent treatment due to recurrence, of which 9 cases were given by secondary MEA and 33 cases (9.9%, 33/334) underwent hysterectomy indicated by frequent menorrhagia, adenomyosis or leiomyoma. A completely destroyed endometrium was observed by hysteroscopy after MEA, pathologic characteristics of MEA showed two zones of necrotic tissue: the inner zone was coagulation necrosis and the outer zone of necrosis was hypocellular hyalinized myometrium. MEA is the safe and efficacious management to treat menorrhagia. Incomplete removal of endometrium was the major reason resulting in postoperative recurrence. Young age and complicated with adenomyosis were the main factors influencing long term clinical effect of MEA.

Previous Tubal Ligation Is a Risk Factor for Hysterectomy After Rollerball Endometrial Ablation

Although most women who undergo rollerball endometrial ablation for the treatment of menorrhagia are very satisfied with the outcome of their surgery, a consistent proportion of patients report continued or worsened symptoms, including pelvic pain and continued menorrhagia. Approximately 10% of women who have endometrial ablation eventually undergo hysterectomy to treat their symptoms. This study investigated the risk factors for failure of rollerball endometrial ablation. All women who underwent endometrial ablation for treatment of menorrhagia at the authors' institutions during the years 1990 to 2000 (N = 240; mean age = 43.1 years) were sent a questionnaire asking about their level of satisfaction with the surgery and any posttreatment problems or further surgeries. One hundred seventy-six (72%) of the 240 women responded and made up the study population. The average time from initial endometrial ablation to questionnaire was 49 months (range = 13-132 months). Seventy-four percent of women reported satisfaction with the outcome of their treatment, and 15% expressed dissatisfaction. Thirteen percent of subjects had either new or worse pelvic pain after treatment. Eleven women underwent a second endometrial ablation, 5 had additional laparoscopic pelvic surgery, and 21 (12%) eventually underwent a hysterectomy. Ninety (51%) of the 176 women who were treated with endometrial ablation had a tubal ligation, 80 of which had been done previously and 10 of which were performed concurrently with ablation. The women who had a tubal ligation were generally younger with a higher gravidity. Both groups reported similar degrees of pelvic pain before endometrial ablation (50%-54%), but women in the tubal ligation group had a higher rate of posttreatment continued (37% vs. 23%, P = .04) and new or worse (21% vs. 5%, P = .001) pelvic pain. They also had a higher rate of hysterectomies performed after endometrial ablation (17% vs. 7%, P = .05). When the results of the questionnaire were subjected to multivariate Cox proportional hazard analysis, tubal ligation was a risk factor for postablation hysterectomy (hazard ratio = 3.3, 95% CI = 1.1-9.7, P = .03) and new or worsened pain (hazard ratio = 3.2, 95% CI = 1.0-10.6, P = .05). In general, age did not predict the rate of hysterectomy or pain, except that women age 40 to 45 years had a greater degree of new pain (hazard ratio = 0.1, 95% CI = 0.01-1.0, P = .05), and women more than 45 years old reported new pain significantly less often than younger women. Increasing age was associated with decreased bleeding after ablation. Women in the youngest age group, less than 35 years, were the only group not likely to have significantly less bleeding after endometrial ablation.

Gynelase system for laser endometrial ablation for treatment of menorrhagia

Gynelase system for laser endometrial ablation for treatment of menorrhagia

Clinical results with cavaterm thermal balloon endometrial ablation for treatment of menorrhagia

Clinical results with cavaterm thermal balloon endometrial ablation for treatment of menorrhagia