Endometrial Ablation—Current Evidence for Patient Optimization and Long-Term Outcomes

Endometrial ablation is a minimally invasive surgical option to treat abnormal uterine bleeding. Here, we summarize the evidence regarding patient optimization prior to endometrial ablation and the long-term outcomes of this procedure. Patient optimization includes preoperative planning, patient selection, and preoperative predictors of postoperative failure. Long-term outcomes include postoperative bleeding patterns, frequency of additional procedures for treatment failure, patient satisfaction, risk of endometrial cancer, and pregnancy outcomes.

Endometrial ablation is a safe procedure to treat abnormal uterine bleeding in high- and low-risk surgical patients. A prior low transverse cesarean section is not a contraindication to the procedure. Young age at ablation (less than 30–45 years of age) is the most significant risk factor for treatment failure. Preoperative dysmenorrhea, large uterine size, fibroids, and prior tubal ligation may also be risk factors for failure. Reduction in menstrual bleeding and patient satisfaction achieved at 12 months usually persist for 5–10 years. There is a 17–25% risk of subsequent hysterectomy that usually occurs within the first 5 years. Endometrial ablation does not appear to increase the risk for developing endometrial cancer. Lastly, outcomes of post-ablation pregnancy are poor, and preoperative counseling should include a discussion about reliable post-ablation contraception.

Endometrial ablation can effectively reduce menstrual blood loss and improve patient satisfaction with effects sustained for years after the procedure and is appropriate to use in high-risk surgical candidates. Younger women should be counseled preoperatively about the risk of treatment failure and need for additional procedures in the future.