Endometrial Ablation Long-term Complications

Endometrial Ablation Long-term Complications

Endometrial Ablation Long-term Complications are not often reported to patients. Complications which are extremely painful and are preventable.

For women suffering with heavy menstrual bleeding, the NICE guidelines (National Institute for Health and Care Excellence) state that conservative treatment should be offered and tried before surgery. Women should be offered medication in the form of progestogen, oral contraceptive, tranexamic acid or non-steroidal anti-inflammatory drugs.

If these treatments are unsuccessful then endometrial ablation is a treatment for dysfunctional uterine bleeding in premenopausal women.

Heavy menstrual bleeding is a common disorder. It is estimated that 1 in 20 women in the UK aged 30–49 years consults her GP each year – approximately 1.5 million women in England and Wales. Referrals for menstrual disorders account for about 20% of all referrals to specialist gynaecology services.

What is Endometrial Ablation?

Ablation aims to reduce the menstrual bleeding by destroying (ablating) the entire thickness of the innermost layer of the uterus (the endometrium). It is also destroys some of the underlying muscular layer (the myometrium) using electrical, thermal or laser energy. The techniques do not guarantee to reduce bleeding completely. It is less invasive than hysterectomy.

Women are recommended preoperative medical therapy to suppress endometrial growth. This is because the ablation is more likely to be successful if the endometrium is thin. It can however result in a perforation of the uterus and need for repair.

It is important to rule out all organic and structural causes of heavy menstrual bleeding before considering ablation. The technique is not suitable for women who wish to maintain fertility. It can result in infertility or an inability to carry a baby to term.

Complications of Ablation

Early complications are usually documented on the consent form. They should be part of the pre-surgical counselling. However little is discussed about the late complications which occur over time.

The long-term complications of endometrial ablation can be extremely painful and debilitating. It may result in a recommendation for hysterectomy.

As time passes certain long-term complications became evident as a result of intrauterine scarring and contracture. Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed. This causes problems such as central hematometra, cornual hematometra, postablation tubal sterilization syndrome, retrograde menstruation, and potential delay in the diagnosis of endometrial cancer.

The incidence of these complications is often understated and not communicated to patients. Many radiologists and pathologists have not been educated about the findings to make the appropriate diagnosis of cornual hematometra and postablation tubal sterilization syndrome. Many doctors when faced with this additional complication recommend hysterectomy whereas uterine saving surgery should be considered first.

It is of concern that when recommending hysterectomy it is often common place to recommend removal of faollopian tubes and ovaries at the same time. This is not a necessary procedure and causes surgical menopause. We have talked this about in other posts which can be accessed here.

Thus is it quite common for women initially suffering with heavy periods of no known cause to end up with a hysterectomy. This is due to failures to treat appropriately and to obtain adequate consent based on counselling.