Incidence of de Novo Pelvic Pain After Radiofrequency or Thermal Balloon Global Endometrial Ablation Therapy

Objective: The purpose of this study was to determine the incidence of new-onset pelvic pain within 2 years after either radiofrequency (RF) or thermal balloon (TB) endometrial ablation for menorrhagia. Study design: This study was a retrospective cohort study of consecutive patients treated by radiofrequency or thermal balloon global endometrial ablation (GEA) between 2003 and 2008. Setting: The study took place in an inner-city, academic teaching hospital (RF cohort), inner-city community-based obstetrics and gynecology private practice (TB cohort). Intervention: Procedures performed were hysteroscopy and endometrial ablation by either radiofrequency (under general anesthesia) or thermal balloon (under local paracervical block). Outcome measure: The primary outcome measure was the incidence of new-onset pelvic pain at 3, 6, 12, 18, and 24 months, and the secondary outcome measure was the mean visual analogue scale (VAS) pain score per modality, per time endpoint. Results: De novo pelvic pain occurred overall in 20% of RF and 7% TB (p-value = 0.01). The incidence of pain was greater after RF than after TB at each time endpoint (p-value = 0 <.05). The radiofrequency cohort had a statistically significant increase in pain incidence at 3-6 (p-value = 0.02), and 6-12 months (p-value = 0.03), with similar findings occurring with thermal balloon between 6 and 12 months (p-value = 0.03). Mean VAS was greater after radiofrequency, at each time endpoint. Conclusions: De novo pelvic pain frequency and severity differ by mode of therapy after GEA. The possibility of de novo pelvic pain after treatment should be reviewed with the patient preprocedure.