Hysteroscopic Appearance of Endometrial Cavity after Microwave Endometrial Ablation
Received 8 May 2009; accepted 24 September 2009.
Abstract
Study Objective
To assess the appearance of the endometrial cavity after microwave endometrial ablation.
Design
Prospective observational study.
Setting
GuangDong Women's and Children's Hospital, GuangDong, China.
Patients
A total of 349 patients who underwent microwave endometrial ablation from January 2000 through August 2008 were followed up for 1 month to 8 years. At follow-up in 2007 and 2008, patients were advised of this clinical study and were randomly selected for participation if they agreed to undergo outpatient hysteroscopy to assess the uterine cavity during follow-up visits. Fifty three patients (median [range] age, 43.1 [33–53] years) were recruited into the study at the time of endometrial ablation.
Intervention
Outpatient hysteroscopy.
Main Results
Within the first 3 months after ablation, outpatient hysteroscopy revealed varying amounts of necrotic tissue from the endometrium and superficial myometrium of the uterus. Six months postablation, a granulomatous reaction and fibrosis were present. A fibrotic cavity was also evident, and menstrual flow was reduced or had ceased. One year after ablation, hysteroscopy demonstrated a fibrotic cavity with myofibrous scars. Most patients developed amenorrhea at this time. Two years or more postablation, a second hysteroscopy demonstrated various types of intrauterine adhesions in 28 of the 53 women (52.8%). A cervical adhesion was observed in 1 patient (1.9%), focal adhesions in the fundal area in 12 (22.6%), a narrowed and scarred uterine cavity with bilateral stenotic tubal ostia in 11 (20.7%), and complete obliteration of the cavity in 4 (7.5%). Of these 28 women, 22 had amenorrhea, 3 had vaginal spotting during menstruation, and 2 had hypomenorrhea. Of those without intrauterine adhesions, only 5 had amenorrhea, 10 had vaginal spotting, and 8 had hypomenorrhea.
Conclusion
The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance.
aDepartment of Gynecology, Guangdong Women's and Children's Hospital, Guangdong, China
bDepartment of Obstetrics and Gynaecology, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia
cSouth Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
Corresponding author: Chi Eung Danforn Lim, MD, Department of Obstetrics and Gynaecology, Liverpool Hospital, Faculty of Medicine, PO Box 3159, Elizabeth St., Liverpool, NSW 2170, Australia.
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.
ABSTRACT