Results of hysteroscopic endometrial ablation after five-year follow-up

PURPOSE: To evaluate the clinical outcomes after a minimum period of 5 years of follow-up of patients with abnormal uterine bleeding of benign etiology who underwent endometrial ablation, analyzing the success rate of treatment defined as patient satisfaction and improvement in uterine abnormal bleeding, as well as late complications and factors associated with recurrence of symptoms. METHODS: A cross-sectional survey was conducted after a minimum period of 5 years after surgery in patients who underwent the procedure between 1999 and 2004. We analyzed the following data: age at the time of surgery, immediate and late complications and associated factors. Logistic regression with Odds Ratio (OR) calculation was performed to evaluate possible associations between the success rate of surgery and the analyzed variables. RESULTS: A total of 114 patients underwent endometrial ablation between March 1999 and April 2004. The median follow-up was 82 months. The logistic regression model allowed the correct prediction of the success of endometrial ablation in 80.6% of cases. Age was directly related to the success of the procedure (OR=1.2; p=0.003) and previous tubal ligation showed a negative association with the success of endometrial ablation (OR=0.3; p=0.049). Among the patients with treatment failure, 21 (72.4%) underwent hysterectomy. In one of the hysterectomy cases, hydro/hematosalpinx was confirmed by the anatomopathological exam, characterizing the postablation-tubal sterilization syndrome. CONCLUSION: Endometrial ablation has proven to be a worthwhile treatment option, maintaining high rates of patient satisfaction, even over long-term follow-up. The age at endometrial ablation influenced the therapeutic success. Further studies are needed to evaluate the factors that may influence the future indication for the procedure in selected cases.