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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