Wishall et al. Postablation risk factors for pain and subsequent hysterectomy
Why should you read about this topic?
Do you have any patients with heavy menstrual bleeding and a history of dysmenorrhea, cesarean delivery, or tubal ligation? If so, you need to read this.
What were the authors trying to do?
Identify factors associated with pain and hysterectomy following endometrial ablation
Who participated and in what setting?
Women (N=270) over 18 years of age who had endometrial ablation (mostly thermal balloon and bipolar radiofrequency) between 2006 and 2013 at Drexel University and the University of Pennsylvania
What was the study design?
Retrospective cohort (chart review)
What were the main outcome measures?
New or worsening pain lasting at least 2 months following the postop visit. Secondary outcome was hysterectomy.
What were the results?
23% of women developed new or worsening pain and 19% had a hysterectomy. Factors associated with increased odds of pain were a history of dysmenorrhea, prior tubal ligation, and non-white race. Women were more likely to have a hysterectomy if they had a cesarean delivery or uterine abnormalities on imaging. They were less likely to have a hysterectomy if the ablation was done in the operating room rather than the office.
What is the most interesting image in the paper?
What were the study strengths and weaknesses?
Strengths: large sample size. Weaknesses: retrospective chart review; more than 25% of eligible patients not evaluated due to missing information or loss to follow-up
What does the study contribute for your practice?
In treatment of heavy menstrual bleeding, endometrial ablation is an alternative but not always a replacement for hysterectomy