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Grand Rounds

What are the Risk Factors for Endometrial Ablation Failure?

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BACKGROUND AND PURPOSE:

  • Endometrial ablation plays an important role in the management of heavy menstrual bleeding, but there is an associated 10–20% failure rate
  • Bleelen et al. (Obstetrics & Gynecology, 2019) examined prognostic factors for ablation failure

METHODS:

  • Systematic review and meta-analysis (1988 to 2019)
  • Data sources
    • MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov
    • No language restrictions
  • Inclusion criteria
    • Studies with data relate to prognostic factors for second-generation endometrial ablation failure
  • Prognostic factors included
    • Age | Myomas | Tubal ligation | BMI | Parity | Preexisting dysmenorrhea | Caesarean | Bleeding pattern | Uterus position and length
  • Data analysis
    • Associations either extracted directly from articles or calculated from raw data if available
  • Primary outcome
    • Surgical reintervention

RESULTS:

  • 56 total studies were included with 21 included in meta-analysis | 157,830 women
  • The following were associated with an increased risk of surgical reintervention
    • Younger patient age
      • ≤35 years: Odds ratio [OR] 1.68 (95% CI, 1.19 to 2.36)
      • Effect of increased risk for reintervention was present up to age 45 compared to those >45 years (pooled OR 1.58 to 1.68)
      • Women with a relatively higher age have a larger reduction of bleeding or a higher percentage of amenorrhea (based on 9 studies)
    • Prior tubal ligation
      • OR 1.46 (95% CI 1.23 to 1.73)
    • Preexisting dysmenorrhea
      • OR 2.12 (95% CI, 1.41 to 3.19)
  • Studies investigating the prognostic factors myomas and obesity showed conflicting results

CONCLUSION:

  • The following were found to be associated with endometrial ablation failure
    • Younger age
    • Prior tubal ligation
    • Preexisting dysmenorrhea
  • The strongest predictor of the 3 was preexisting dysmenorrhea
    • Authors suggest that endometriosis or adenomyosis may be the underly mechanism resulting in heavy menses
    • Ablation may relieve a symptom and not the cause
  • Obesity and the presence of large submucous myomas may also be associated with failure
    • The authors suggest more research required to understand role of these factors in ablation failure

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Learn More – Primary Sources:

Prognostic Factors for the Failure of Endometrial Ablation – A Systematic Review and Meta-analysis

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Related ObG Topics:

What are the Risk Factors Associated with Endometrial Ablation?
Results from the HEALTH Trial: Supracervical hysterectomy or Endometrial Ablation for Menorrhagia?
IUD, Hysterectomy or Ablation for Menorrhagia?

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