Our Summary

Endometrial ablation is a procedure that is often used to treat abnormal bleeding from the uterus. It’s seen as a less invasive alternative to a full-blown hysterectomy (removal of the uterus). However, in some cases, if the ablation doesn’t work, a hysterectomy may still be needed. The researchers in this study wanted to look at what changes occur in the uterus after ablation, but before a hysterectomy is performed.

Over a period of ten years, they studied 321 patients who had undergone endometrial ablation. They found that 25 of these patients (around 8%) eventually needed a hysterectomy, mainly because of continued bleeding. These patients were divided into two groups depending on the type of ablation they had (NovaSure® or ThermaChoice®).

The researchers found that the time between the ablation and the hysterectomy varied from 2 to 24 months for the NovaSure® group and 2 to 60 months for the ThermaChoice® group. They also found that the uteruses that were removed later (on average, 22 months after ablation) had no fibrosis (a kind of tissue scarring), compared to those removed earlier. The lining of the uterus was also more likely to be found in uteruses removed later.

Around 28% of the cases had a lot of dead tissue from the muscle layer of the uterus, but this wasn’t linked to the timing of the hysterectomy. Other changes they found included a zoning effect and changes to the blood vessels. They didn’t find any granulomatous reaction (a type of inflammation).

They also found that 10 patients (40%) had adenomyosis (a condition where the inner lining of the uterus breaks through the muscle wall of the uterus) and three patients (12%) had large or many fibroids (non-cancerous growths in the uterus).

In conclusion, they found that in the first year after ablation, there’s a lot of tissue death, scarring, and changes to the blood vessels in the uterus. If a hysterectomy is performed later, these changes are less severe and the lining of the uterus is almost normal. Adenomyosis is also common in these patients.

FAQs

  1. What is endometrial ablation and why is it used as an alternative to hysterectomy?
  2. What are the most common histological findings in post-endometrial ablation uteri?
  3. What are the differences between the NovaSure® and ThermaChoice® endometrial ablation treatments in terms of patient age and time from ablation to hysterectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about endometrial ablation is to be aware that histological changes in the uterus can occur post-treatment, including necrosis, fibrosis, and vascular changes. It is important to follow up with your doctor regularly to monitor any changes and discuss any symptoms or concerns.

Suitable For

Patients who are typically recommended for endometrial ablation are those who suffer from abnormal uterine bleeding that has not responded to other treatments, such as medication or hormonal therapy. Endometrial ablation may be recommended for patients who wish to avoid a hysterectomy, as it is a less invasive procedure with a quicker recovery time.

In the study mentioned above, patients who underwent endometrial ablation with either NovaSure® or ThermaChoice® and later required hysterectomy mostly due to persistent uterine bleeding were evaluated. The study found that histological changes in the post-treatment uteri included necrosis, fibrosis, and vascular changes, with more prominent changes seen in hysterectomies performed earlier after the ablation procedure compared to those performed later.

Additionally, adenomyosis, a condition where endometrial tissue grows into the muscular wall of the uterus, was found in a significant portion of the post-endometrial ablation hysterectomies. This suggests that patients with adenomyosis may benefit from endometrial ablation as a treatment option for their abnormal uterine bleeding.

Overall, patients who are recommended for endometrial ablation are those with abnormal uterine bleeding who have not responded to other treatments and wish to avoid a hysterectomy. It is important for these patients to be aware of the potential histological changes that may occur in the uterus post-treatment, as described in the study.

Timeline

  • Before endometrial ablation: The patient experiences abnormal uterine bleeding and may have tried other treatments such as medication or hormonal therapy.
  • Endometrial ablation procedure: The patient undergoes a minimally invasive procedure to destroy the lining of the uterus to reduce or eliminate abnormal bleeding.
  • After endometrial ablation: The patient may experience a reduction or cessation of abnormal bleeding, but in cases of treatment failure, further interventions may be necessary.
  • Hysterectomy: In cases where endometrial ablation is not successful, the patient may eventually undergo a hysterectomy. Histological findings in post-endometrial ablation uteri show necrosis, fibrosis, vascular changes, and the presence of adenomyosis or leiomyomas. Hysterectomies performed later show less prominent changes and almost normal endometrial lining.

What to Ask Your Doctor

  1. What are the potential risks and side effects of endometrial ablation?
  2. How long does the procedure typically take and what is the recovery time?
  3. What are the chances of needing a hysterectomy after undergoing endometrial ablation?
  4. How long do the effects of endometrial ablation typically last?
  5. What are the chances of experiencing abnormal bleeding or other symptoms after the procedure?
  6. Will I still be able to get pregnant after having endometrial ablation?
  7. Are there any specific lifestyle changes or restrictions I should follow after the procedure?
  8. What are the alternatives to endometrial ablation if this procedure is not successful?
  9. How often should I follow up with you after the procedure?
  10. Are there any long-term effects or complications I should be aware of?

Reference

Authors: Karpathiou G, Chauleur C, Dal Col P, Dridi M, Laville D, Mobarki M, Peoc’h M. Journal: Pathol Res Pract. 2020 Aug;216(8):152992. doi: 10.1016/j.prp.2020.152992. Epub 2020 May 4. PMID: 32475645