Endometrial ablation Flashcards
from TOG
Principle of endometrial ablation
Destroy functionally active endometrial glands in the endomyometrial junction and up to 5mm of the myometrium to reduce HMB
Types of 1st gen endometrial ablation techniques?
Transcervical resection of endometrium TCRE
Roller ball endometrial ablation
Endometrial laser ablation (Nd:YAG laser)
Types of 2nd gen endometrial ablation techniques
Thermal balloon ablation
Bipolar radiofrequency endometrial ablation e.g. Novasure
Hydrothermal ablation
Why is hysterectomy considered a better treatment option over endometrial ablation?
20% will have a hysterectomy by 5 years due to recurrence of symptoms
Endo ablation renders the cavity potentially difficult for future evaluation in PMB
Need to use contraception after endo ablation - getting pregnant comes with signif risks
Perioperative complications of endometrial ablation
Fluid overload causing transurethral resection syndrome
Haemorrhage
Uterine performation
Cervical lacerations
Extrauterine thermal damage
Haematometra
What is transurethral resection syndrome
Occurs secondary to glycine overload
Can result in hyponatraemia, hyperammonaemia, congestive heart failure, haemolysis, coma
Long-term post-ablation complications?
Infection - endometritis, PID, pelvic abscess.
Post-ablation syndrome - new-onset or worsening of pain during menstruation thought to be due to haematometra caused by scarring.
Post-ablation tubal sterilisation syndrome - cyclical uni/bilateral pain with vaginal spotting due to retrograde menstruation into tubes
Who might not be suitable for endometrial ablation?
Women with endometrial hyperplasia of risk factors e.g. obesity
Large uterine cavities >10cm
