Endometrial ablation

Question 1

absolute contraindications to endometrial ablation

Answer 1

• pregnancy
• active pelvic infection
• endometrial hyperplasia or cancer
• planning future fertility
• post-menopausal
• IUD in place

Question 2

relative contraindications to endometrial ablation

Answer 2

• congenital uterine anomalies
• thin endometrium
• uterine cavity length greater than device specifications (typically 10-12 cm)
• ovulatory dysfunction

Question 3

efficacy

Answer 3

• 20-40% amenorrhea at 1 year
• 50% at 2-5 years
• 80-90% satisfaction with procedure (not as high as hyst)
• 24% undergo hysterectomy in 4 years

regulation of periods is more realistic goal than amenorrhea

Question 4

what are the two categories of endometiral ablation instruments/techniques?

Answer 4

• resectoscopic: direct visualization, roller ball, barrel shaped. 1st generation
• non-resectoscopic: cryotherapy, heat free fluid, microwave thermal ballon, radiofrequency electricity (NovaSure)

both equally efficacious

Question 5

risks

Answer 5

• fluid overload
• electrolyte disturbances
• perforation
• post-ablation tubal syndrome (if hx of tubal ligation)

Question 6

preoperative treatment to improve outcomes?

Answer 6

-yes with GnRH agonist: increases amenorrhea rates, ease of procedure, and shortens length of procedure

Question 7

which has fewer complications: resectoscopic vs non-resectoscopic?

Answer 7

non-resectoscopic: fewer distention fluid overload, cervical lacerations, perforation, hematometria

Question 8

what special considerations with hx of classical CD or intransmural myomectomy?

Answer 8

increased risk of damage to surrounding structures

• resectoscopic
• simultaneous laparoscpic visualization

Question 9

what pre-operative eval do you need?

Answer 9

• EMB/D&C

- uterine imaging