Prediction of treatment outcomes after global endometrial ablation
Sherif A El-Nashar, Matthew R Hopkins, Douglas J Creedon, Jennifer L St Sauver, Amy L Weaver, Michaela E McGree, William A Cliby, Abimbola O Famuyide, Sherif A El-Nashar, Matthew R Hopkins, Douglas J Creedon, Jennifer L St Sauver, Amy L Weaver, Michaela E McGree, William A Cliby, Abimbola O Famuyide
Abstract
Objective: To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models.
Methods: From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radio frequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure. Treatment failure was defined as hysterectomy or reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes.
Results: The amenorrhea rate was 23% (95% confidence interval [CI] 19-28%) and the 5-year cumulative failure rate was 16% (95% CI 10-20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR] 2.6, 95% CI 1.6-4.3); uterine length less than 9 cm (aOR 1.8, 95% CI 1.1-3.1); endometrial thickness less than 4 mm (aOR 2.7, 95% CI 1.2-6.3); and use of radio-frequency ablation instead of thermal balloon ablation (aOR 2.8, 95% CI 1.7-4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR] 2.6, 95% CI 1.3-5.1); parity of 5 or greater (aHR 6.0, 95% CI 2.5-14.8); prior tubal ligation (aHR 2.2, 95% CI 1.2-4.0); and history of dysmenorrhea (aHR 3.7, 95% CI 1.6-8.5). After global endometrial ablation, 23 women (5.1%, 95% CI 3.2-7.5%) had pelvic pain, three (0.7%, 95% CI 0.1-1.9%) were pregnant, and none (95% CI 0-0.8%) had endometrial cancer.
Conclusion: Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal preprocedural patient counseling.
Level of evidence: II.
Conflict of interest statement
Financial Disclosure: The authors have no potential conflicts of interest to disclose.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2977517/bin/nihms107695f1.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2977517/bin/nihms107695f2.jpg)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2977517/bin/nihms107695f3a.jpg)
Figure 3
Predicted cumulative treatment failure rates…
Figure 3
Predicted cumulative treatment failure rates for preoperative variables (final model). A, Age (…
Figure 3
Predicted cumulative treatment failure rates…
Figure 3
Predicted cumulative treatment failure rates for preoperative variables (final model). A, Age (…
Figure 3
Predicted cumulative treatment failure rates…
Figure 3
Predicted cumulative treatment failure rates for preoperative variables (final model). A, Age (…
- Prediction of treatment outcomes after global endometrial ablation.McCausland AM, McCausland VM. McCausland AM, et al. Obstet Gynecol. 2009 Jun;113(6):1370. doi: 10.1097/AOG.0b013e3181a82cc9. Obstet Gynecol. 2009. PMID: 19461441 No abstract available.
- Efficacy of bipolar radiofrequency endometrial ablation vs thermal balloon ablation for management of menorrhagia: A population-based cohort.El-Nashar SA, Hopkins MR, Creedon DJ, Cliby WA, Famuyide AO. El-Nashar SA, et al. J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):692-9. doi: 10.1016/j.jmig.2009.06.022. J Minim Invasive Gynecol. 2009. PMID: 19896595 Free PMC article.
- Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction: A Cohort Study.Hokenstad AN, El-Nashar SA, Khan Z, Hopkins MR, Famuyide AO. Hokenstad AN, et al. J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1225-30. doi: 10.1016/j.jmig.2015.06.020. Epub 2015 Jul 4. J Minim Invasive Gynecol. 2015. PMID: 26149205
- Nonresectoscopic endometrial ablation in high-risk surgical patients: a cohort study.Ajao MO, El-Nashar SA, Khan Z, Hopkins MR, Creedon DJ, Famuyide AO. Ajao MO, et al. J Minim Invasive Gynecol. 2013 Jul-Aug;20(4):487-91. doi: 10.1016/j.jmig.2013.02.005. J Minim Invasive Gynecol. 2013. PMID: 23870238
- Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Fergusson RJ, et al. Cochrane Database Syst Rev. 2013 Nov 29;(11):CD000329. doi: 10.1002/14651858.CD000329.pub2. Cochrane Database Syst Rev. 2013. PMID: 24288154 Updated. Review.
- Meta-analysis of bipolar radiofrequency endometrial ablation versus thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding.Zhai Y, Zhang Z, Wang W, Zheng T, Zhang H. Zhai Y, et al. Int J Gynaecol Obstet. 2018 Jan;140(1):3-10. doi: 10.1002/ijgo.12340. Epub 2017 Nov 9. Int J Gynaecol Obstet. 2018. PMID: 28984905 Review.
- Research Support, U.S. Gov't, P.H.S.
- Adult
- Amenorrhea
- Endometrial Ablation Techniques* / methods
- Female
- Humans
- Hysterectomy
- Menorrhagia / surgery*
- Middle Aged
- Retreatment
- Treatment Failure
- Treatment Outcome
- Full Text Sources
- Medical
- Research Materials
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2977517/bin/nihms107695f3b.jpg)
Figure 3
Predicted cumulative treatment failure rates…
Figure 3
Predicted cumulative treatment failure rates for preoperative variables (final model). A, Age (…
Figure 3
Predicted cumulative treatment failure rates…
Figure 3
Predicted cumulative treatment failure rates for preoperative variables (final model). A, Age (…
- Prediction of treatment outcomes after global endometrial ablation.McCausland AM, McCausland VM. McCausland AM, et al. Obstet Gynecol. 2009 Jun;113(6):1370. doi: 10.1097/AOG.0b013e3181a82cc9. Obstet Gynecol. 2009. PMID: 19461441 No abstract available.
- Efficacy of bipolar radiofrequency endometrial ablation vs thermal balloon ablation for management of menorrhagia: A population-based cohort.El-Nashar SA, Hopkins MR, Creedon DJ, Cliby WA, Famuyide AO. El-Nashar SA, et al. J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):692-9. doi: 10.1016/j.jmig.2009.06.022. J Minim Invasive Gynecol. 2009. PMID: 19896595 Free PMC article.
- Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction: A Cohort Study.Hokenstad AN, El-Nashar SA, Khan Z, Hopkins MR, Famuyide AO. Hokenstad AN, et al. J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1225-30. doi: 10.1016/j.jmig.2015.06.020. Epub 2015 Jul 4. J Minim Invasive Gynecol. 2015. PMID: 26149205
- Nonresectoscopic endometrial ablation in high-risk surgical patients: a cohort study.Ajao MO, El-Nashar SA, Khan Z, Hopkins MR, Creedon DJ, Famuyide AO. Ajao MO, et al. J Minim Invasive Gynecol. 2013 Jul-Aug;20(4):487-91. doi: 10.1016/j.jmig.2013.02.005. J Minim Invasive Gynecol. 2013. PMID: 23870238
- Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Fergusson RJ, et al. Cochrane Database Syst Rev. 2013 Nov 29;(11):CD000329. doi: 10.1002/14651858.CD000329.pub2. Cochrane Database Syst Rev. 2013. PMID: 24288154 Updated. Review.
- Meta-analysis of bipolar radiofrequency endometrial ablation versus thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding.Zhai Y, Zhang Z, Wang W, Zheng T, Zhang H. Zhai Y, et al. Int J Gynaecol Obstet. 2018 Jan;140(1):3-10. doi: 10.1002/ijgo.12340. Epub 2017 Nov 9. Int J Gynaecol Obstet. 2018. PMID: 28984905 Review.
- Research Support, U.S. Gov't, P.H.S.
- Adult
- Amenorrhea
- Endometrial Ablation Techniques* / methods
- Female
- Humans
- Hysterectomy
- Menorrhagia / surgery*
- Middle Aged
- Retreatment
- Treatment Failure
- Treatment Outcome
- Full Text Sources
- Medical
- Research Materials
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2977517/bin/nihms107695f3c.jpg)
Figure 3
Predicted cumulative treatment failure rates…
Figure 3
Predicted cumulative treatment failure rates for preoperative variables (final model). A, Age (…
- Prediction of treatment outcomes after global endometrial ablation.McCausland AM, McCausland VM. McCausland AM, et al. Obstet Gynecol. 2009 Jun;113(6):1370. doi: 10.1097/AOG.0b013e3181a82cc9. Obstet Gynecol. 2009. PMID: 19461441 No abstract available.
- Efficacy of bipolar radiofrequency endometrial ablation vs thermal balloon ablation for management of menorrhagia: A population-based cohort.El-Nashar SA, Hopkins MR, Creedon DJ, Cliby WA, Famuyide AO. El-Nashar SA, et al. J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):692-9. doi: 10.1016/j.jmig.2009.06.022. J Minim Invasive Gynecol. 2009. PMID: 19896595 Free PMC article.
- Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction: A Cohort Study.Hokenstad AN, El-Nashar SA, Khan Z, Hopkins MR, Famuyide AO. Hokenstad AN, et al. J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1225-30. doi: 10.1016/j.jmig.2015.06.020. Epub 2015 Jul 4. J Minim Invasive Gynecol. 2015. PMID: 26149205
- Nonresectoscopic endometrial ablation in high-risk surgical patients: a cohort study.Ajao MO, El-Nashar SA, Khan Z, Hopkins MR, Creedon DJ, Famuyide AO. Ajao MO, et al. J Minim Invasive Gynecol. 2013 Jul-Aug;20(4):487-91. doi: 10.1016/j.jmig.2013.02.005. J Minim Invasive Gynecol. 2013. PMID: 23870238
- Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Fergusson RJ, et al. Cochrane Database Syst Rev. 2013 Nov 29;(11):CD000329. doi: 10.1002/14651858.CD000329.pub2. Cochrane Database Syst Rev. 2013. PMID: 24288154 Updated. Review.
- Meta-analysis of bipolar radiofrequency endometrial ablation versus thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding.Zhai Y, Zhang Z, Wang W, Zheng T, Zhang H. Zhai Y, et al. Int J Gynaecol Obstet. 2018 Jan;140(1):3-10. doi: 10.1002/ijgo.12340. Epub 2017 Nov 9. Int J Gynaecol Obstet. 2018. PMID: 28984905 Review.
- Research Support, U.S. Gov't, P.H.S.
- Adult
- Amenorrhea
- Endometrial Ablation Techniques* / methods
- Female
- Humans
- Hysterectomy
- Menorrhagia / surgery*
- Middle Aged
- Retreatment
- Treatment Failure
- Treatment Outcome
- Full Text Sources
- Medical
- Research Materials
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2977517/bin/nihms107695f3d.jpg)
Source: PubMed