Hysteroscopy pp 521-530 | Cite as

Predictors of Endometrial Ablation Failure



Heavy menstrual bleeding is well defined as regular, cyclic, ovulatory bleeding that is excessive enough for a woman to disrupt her quality of life. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) revised the classification system of reasons for abnormal uterine bleeding, including heavy menses. The acronym used is PALM-COEIN (Table 47.1) [1]. An annual prevalence rate of 53 per 1000 women for abnormal uterine bleeding has been reported by a US population-based study of women aged 18–50 years [2]. This high prevalence can lead to a burden in women’s health and quality of life along with health care costs if the appropriate therapeutic modality is not chosen.


  1. 1.
    Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3.CrossRefPubMedGoogle Scholar
  2. 2.
    Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992. Am J Public Health. 1996 Feb;86(2):195–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Clarke A, Black N, Rowe P, et al. Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study. Br J Obstet Gynaecol. 1995;102:611–20.CrossRefPubMedGoogle Scholar
  4. 4.
    National Women’s Health Resource Center. National survey of 653 women, 35–49 with reported heavy periods and intact uterus; conducted Sept 29–Oct 12, 2005. Yonkers, NY: National Women’s Health Resource Center.Google Scholar
  5. 5.
    Zupi E, et al. Hysteroscopic endometrial resection versus laparoscopic supracervical hysterectomy for menorrhagia: a prospective randomized trial. Am J Obstet Gynecol. 2003;188:7–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Hidlebaugh DA. Cost and quality-of-life issues associated with different surgical therapies for the treatment of abnormal uterine bleeding. Obstet Gynecol Clin N Am. 2000;27:451–65.CrossRefGoogle Scholar
  7. 7.
    Eskander M, et al. Hysteroscopic endometrial ablation is an effective alternative to hysterectomy in women with menorrhagia and large uteri. J Am Assoc Gynecol Laparosc. 2000;7:339–45.CrossRefGoogle Scholar
  8. 8.
    Lethaby A, et al. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;2:CD000329.Google Scholar
  9. 9.
    Brumsted J, et al. Hysteroscopy versus hysterectomy for the treatment of abnormal uterine bleeding: a comparison of cost. Fertil Steril. 1996;65:310–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Pinion S, et al. Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding. BMJ. 1994;309:979–83.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bardenheuer FH. Elextrokoagulation der uterusschleimhaut zur behandlung klimakterischer blutungen. Zentralbl Gynakol. 1937;4:209–11.Google Scholar
  12. 12.
    Baumann A. Electrocoagulation of endometrium and cervical mucosa (for uterine hemorrhage and leakorrhea) [in German]. Gerburtshilfe Frauenheilkd. 1948;8:221–6.Google Scholar
  13. 13.
    Cahan W, Brockunier A. Cryosurgery of the uterine cavity. Am J Obstet Gynaecol. 1967;99(1):38–53.CrossRefGoogle Scholar
  14. 14.
    Droegemueller W, Makowski E, Macsalka R. Destruction of the endometrium by cryosurgery. Am J Obstet Gynecol. 110:467.Google Scholar
  15. 15.
    Droegemueller W, Greer B, Makowski E. Cryosurgery in patients with dysfunctional uterine bleeding. Obstet Gynecol. 38:256.Google Scholar
  16. 16.
    Goldrath MH, Fuller TA, Segal S. Laser photovaporization of the endometrium for the treatment of menorrhagia. Am J Obstet Gynecol. 1981;140:14–9.CrossRefPubMedGoogle Scholar
  17. 17.
    DeCherney AH, Polan ML. Hysteroscopic management of intrauterine lesions and intractable uterine bleeding. Obstet Gynecol. 1983;61:392–7.PubMedGoogle Scholar
  18. 18.
    Vilos GA. Hysteroscopic and nonhysteroscopic endometrial ablation. Obstet Gynecol Clin N Am. 2004;31:687–704.CrossRefGoogle Scholar
  19. 19.
    Lin BL, Miyamoto N, Tomomatu M, et al. The development of a new hysteroscopic resectoscope and its clinical applications on transcervical resection and endometrial ablation. Japan J Gyncol Obstet Endosc. 1988;4:56–9.Google Scholar
  20. 20.
    Vancaillie TG. Eletrocoagulation of the endometrium with the ball-ended resectoscope. Obstet Gynecol. 1989;74:425–7.PubMedGoogle Scholar
  21. 21.
    Lethaby A, Hickey M, Garry R. Endometrial destruction techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005;4:CD001501. Review. Update in: Cochrane Database Syst Rev 2009;(4):CD001501Google Scholar
  22. 22.
    ACOG Committee on Practice Bulletins. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007;109:1233.CrossRefGoogle Scholar
  23. 23.
    Soysal ME, Soysal SK, Vicdan K. Thermal balloon ablation in myoma-induced menorrhagia under local anesthesia. Gynecol Obstet Investig. 2001;51:128.CrossRefGoogle Scholar
  24. 24.
    Lee C, Wang C, Yen C, et al. Uterovaginal canalization and endometrial ablation of the obstructed uterine horn with hypoplastic cervix in the didelphic uterus. J Am Assoc Gynecol Laparosc. 2001;8:151–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Thamban S, Garg S, Al-Habib A, et al. Thermal balloon endometrial ablation in bicornuate uteri. J Obstet Gynaecol. 2007;27:324.CrossRefPubMedGoogle Scholar
  26. 26.
    Ammar K, Koukoura O. Management of menorrhagia with hydrothermal endometrial ablation in 2 women with bicornuate uteri. J Minin Invasive Gynecol. 2009;16:795.CrossRefGoogle Scholar
  27. 27.
    ACOG. ACOG practice bulletin no. 81. Endometrial ablation. Obstet Gynecol. 2007;109:1233–48.CrossRefGoogle Scholar
  28. 28.
    Practice Committee of American Society for Reproductive Medicine. Indications and options for endometrial ablation. Fertil Steril. 2008;90:S236–40.Google Scholar
  29. 29.
    Garry R. Endometrial ablation and resection: validation of a new surgical concept. Br J Obstet Gynaecol. 1997;104:1329–31.CrossRefPubMedGoogle Scholar
  30. 30.
    Wright C. Laser surgery in gynecology: a clinical guide. Philadelphia, PA: Saunders; 1993. p. 255–8.Google Scholar
  31. 31.
    Lomano J. Dragging technique versus blanching technique for endometrial ablation with the Nd:YAG laser in the treatment of chronic menorrhagia. Am J Obstet Gynecol. 1988;159:152–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Garry R, et al. A multi-centre collaborative study into the treatment of menorrhagia by Nd-YAG laser ablation of the endometrium. Br J Obstet Gynaecol. 1991;98:357–62.CrossRefPubMedGoogle Scholar
  33. 33.
    Isaacson K. 2009. Endometrial ablation. Uptodatecom.Google Scholar
  34. 34.
    Bhattacharya S, et al. A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laserablation for the treatment of menorrhagia. Br J Obstet Gynaecol. 1997 May;104(5):601–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Rosenbaum S, Fried M, Munro M. Enodmetrial hydrothermablation: a comparison of short-term clinical effectiveness in patients with normal endometrial cavities and those with intracavitary pathology. J Minim Invasive Gynecol. 2005;12(2):144–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Hachmann-Nielsen E, Rudnicki M. Clinical outcome after hydrothermal ablation treatment of menorrhagia in patients with and without submucous myomas. J Minim Invasive Gynecol. 2012;19(2):212–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Hawe J, Abbott J, Hunter D, et al. A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding. BJOG. 2003;110:350–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Brun J-L, Raynal J, Burlet G, et al. Cavaterm thermal balloon endometrial ablation versus hysteroscopic endometrial resection to treat menorrhagia: the French, multicenter, randomized study. J Minim Invasive Gynecol. 2006;13:424–30.CrossRefPubMedGoogle Scholar
  39. 39.
  40. 40.
    Leyland N. Office based global endometrial ablation: feasibility & outcome for 3 modalities, presentation to SOGC. Edmonton, AB: SOGC; 2004.Google Scholar
  41. 41.
    Sabbah R, et al. Use of the NovaSure impedance controlled endometrial ablation system in patients with intracavitary disease: 12-month follow-up results of a prospective, single-arm clinical study. J Minim Invasive Gynecol. 2006;13(5):467–71.CrossRefPubMedGoogle Scholar
  42. 42.
    Townsend D, Bruno R. Impact of extended freeze patterns on menorrhagia. Innovative technologies in operative gynecology for the 21st century. Park City, UT: American Society for Bioethics and Humanities; 2005.Google Scholar
  43. 43.
    Laberge P, Garza-Leal J, Fortin C, et al. A randomized controlled multicenter US Food and Drug Administration trial of the safety and efficacy of the Minerva endometrial ablation system: one-year follow-up results. J Minim Invasive Gynecol. 2017;24:124–32.CrossRefPubMedGoogle Scholar
  44. 44.
    McCausland A, McCausland V. Long-term complications on endometrial ablation: cause, diagnosis, treatment, and prevention. J Minim Invasive Gynecol. 2007;14(4):399–406.CrossRefPubMedGoogle Scholar
  45. 45.
    Wortman M, Daggett A, Deckman A. Ultrasound-guided reoperative hysteroscopy for managing global endometrial ablation failures. J Minim Invasive Gynecol. 2014;21:238–44.CrossRefPubMedGoogle Scholar
  46. 46.
    McCausland A, McCausland V. Intrauterine scarring as a result of total endometrial ablation could delay the diagnosis of endometrial cancer. Am J Obstet Gynecol. 1999;180:1598–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Ahonkallio S, Liakka A, Martikainen H, et al. Feasibility of endometrial assessment after thermal ablation. Eur J Obstet Gynecol Reprod Biol. 2009;147:69–71.CrossRefPubMedGoogle Scholar
  48. 48.
    Hamou J. Partial endometrial ablation. In: Hamou J, Taylor P, editors. Hysteeroscopic and microcolpohysteroscopy text and atlas. East Norwalk, CT: Appleton & Lange; 1991. p. 186–7.Google Scholar
  49. 49.
    McCausland A, McCausland V. Partial rollerball endometrial ablation: a modification of total ablation to treat menorrhagia without causing complications from intrauterine adhesions. Am J Obstet Gynecol. 1999;180:1512–21.CrossRefPubMedGoogle Scholar
  50. 50.
    Foote M, Rouse A, Gil K, et al. Successful pregnancy following both endometrial ablation and uterine artery embolization. Fertil Steril. 2007;88:1676.e15–7.CrossRefGoogle Scholar
  51. 51.
    Kuzel D, Bartosova L, Rezabek K, et al. Successful pregnancy after thermal balloon endometrial ablation followed by in vitro fertilization and embryo transfer. Fertil Steril. 2010;93(3):1006.e11.CrossRefGoogle Scholar
  52. 52.
    Hare A, Olah K. Pregnancy following endometrial ablation. A review article. J Obstet Gynecol. 2005;25:108.CrossRefGoogle Scholar
  53. 53.
    Roux I, Das M, Fernandez H, et al. Pregnancy after endometrial ablation. A report of three cases. J Reprod Med. 2013;58:173–6.PubMedGoogle Scholar
  54. 54.
    Laberge P. Serious and deadly complications from pregnancy after endometrial ablation: two case reports and review of the literature. J Gynecol Obstet Biol Reprod. 2008;37:609.CrossRefGoogle Scholar
  55. 55.
    Bowling M, Ramsey P. Spontaneous uterine rupture in pregnancy after endometrial ablation. Obstet Gynecol. 2010;115:405–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Comino R, Torrejón R. Hysterectomy after endometrial ablation-resection. J Am Assoc Gynecol Laparosc. 2004;11(4):495–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Fürst S, Philipsen T, Joergensen J. Ten-year follow-up of endometrial ablation. Acta Obstet Gynecol Scand. 2007;86(3):334–8.CrossRefPubMedGoogle Scholar
  58. 58.
    Longinotti M, Jacobson G, Hung Y, et al. Probability of hysterectomy after endometrial ablation. Obstet Gynecol. 2008;112:1214–20.CrossRefPubMedGoogle Scholar
  59. 59.
    El-Nashar S, Hopkins M, Creedon D, et al. Prediction of treatment outcomes after global endometrial ablation. Obstet Gynecol. 2009;113:97–106.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Shavell V, Diamond M, Senter J, et al. Hysterectomy subsequent to endometrial ablation. J Minim Invasive Gynecol. 2012;19:459–64.CrossRefPubMedGoogle Scholar
  61. 61.
    Peeters J, Penninx J, Mol B, et al. Prognostic factors for the success of endometrial ablation in the treatment of menorrhagia with special reference to previous cesarean section. Eur J Obstet Gynecol Reprod Biol. 2013;167:100–3.CrossRefPubMedGoogle Scholar
  62. 62.
    Thomassee M, Curlin H, Yunker A, et al. Predicting pelvic pain after endometrial ablation: which preoperative patient characteristics are associated? J Minim Invasive Gynecol. 2013;20:642–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Shazly S, Famuyide A, El-Nashar S, et al. Intraoperative predictors of long-term outcomes after radiofrequency endometrial ablation. J Minim Invasive Gynecol. 2016;23:582–9.CrossRefPubMedGoogle Scholar
  64. 64.
    Wishall K, Price J, Pereira N, et al. Postablation risk factors for pain and subsequent hysterectomy. Obstet Gynecol. 2014;124:904–10.CrossRefPubMedGoogle Scholar
  65. 65.
    Smithling K, Savella G, Raker C, et al. Preoperative uterine bleeding pattern and risk of endometrial ablation failure. Am J Obstet Gynecol. 2014;211:556.e1–6.CrossRefGoogle Scholar
  66. 66.
    Carey E, El-Nashar S, Hopkins M, et al. Pathologic characteristics of hysterectomy specimens in women undergoing hysterectomy after global endometrial ablation. J Minim Invasive Gynecol. 2011;18:96–9.CrossRefPubMedGoogle Scholar
  67. 67.
    Simon R, Quddus M, Lawrence W, et al. Pathology of endometrial ablation failures: a clinicopathologic study of 164 cases. Int J Gynecol Pathol. 2015;34:245–52.CrossRefPubMedGoogle Scholar
  68. 68.
    Bansi-Matharu L, Gurol-Urganci I, Mahmood T, et al. Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study. BJOG. 2013;120:1500–7.CrossRefPubMedGoogle Scholar
  69. 69.
    Wortman M, Cholkeri A, McCausland A, et al. Late-onset endometrial ablation failure – etiology, treatment, and prevention. J Minim Invasive Gynecol. 2015;22:323–31.CrossRefPubMedGoogle Scholar
  70. 70.
    McCausland A, McCausland V. Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation. Am J Obstet Gynecol. 1996;174:1793–4.CrossRefGoogle Scholar
  71. 71.
    Wortman M, Daggett A. Hysteroscopic endomyometrial resection. JSLS. 2000;4:197–207.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Madsen A, El-Nashar S, Hopkins M, et al. Endometrial ablation for the treatment of heavy menstrual bleeding in obese women. Int J Gynaecol Obstet. 2013;121:20–3.CrossRefPubMedGoogle Scholar
  73. 73.
    Fakih M, Cherfan V, Abdallah E. Success rate, quality of life, and descriptive analysis after generalized endometrial ablation in an obese population. Int J Gyaecol Obstet. 2011;113:120–3.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Advocate Lutheran General HospitalPark RidgeUSA
  2. 2.Department of Obstetrics and GynaecologyUniversity of Illinois at ChicagoChicagoUSA
  3. 3.The Advanced Gynecologic Surgery InstituteNapervilleUSA

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