Does Ablation Lead to Hysterectomy?

In women who have endometriosis, ablation procedures are commonly completed to destroy endometrial tissue lining the uterus. A goal of ablation is to disrupt severe bleeding that can lead to other conditions including anemia. Research published in last month's Obstetrics & Gynecology identified the risk factors for pain and subsequent hysterectomy following ablation procedures for endometriosis. Of 300 women, 270 completed follow-up, and the resultant data was reported:

• -23% developed new onset or worsening pain after the ablation

• -19% proceeded to hysterectomy

• -a history of dysmenorrhea increased the risk of developing pain by 74%

• -a history of tubal sterilization increased the risk of developing pain by > 50%

• -women of white race were 45% less likely to develop pain

• -a history of cesarean delivery more than doubled risk of hysterectomy

• -uterine abnormalities such as leiomyoma, adenomyosis, thickened endometrial strip, or polyps quadrupled the risk for hysterectomy

For the nearly 20% of these women who had a hysterectomy after ablation therapy, the most common indication for the hysterectomy was pain. Regarding the increased risk of pain after ablation in non-white women, the authors proposed the higher rates of leimyomatous uteri in African American women (largest population of non-white women in the study) as a source. Because pain is a potential complication of endometrial ablation, the authors of this article recommend that providers consider patient characteristics when educating patients about the potential benefits and risks of the procedure.

Although in pelvic rehabilitation we do not counsel for or against surgical procedures, knowledge of the potential risk factors for our patients who have had or who are having a uterine ablation can assist in our screening and interventions. If a patient asks our opinion about uterine ablation, pointing out research such as the linked article may help her discuss pros and cons with us and with her providers. The need for patients to understand the potential side effects of a uterine ablation and to actively manage her recovery may be important in avoiding hysterectomy, if that is the patient's goal. Endometriosis is one of the main topics in a new course offered by faculty member Michelle Lyons. The new continuing education course "Special Topics in Women's Health: Endometriosis, Infertility, and Hysterectomy" will be offered in March in San Diego and the Chicago area in May.