Long-Term Complications of Minimally Invasive Endometrial Ablation Devices

Background: Endometrial ablations are very effective in treating intractable uterine bleeding. They are much safer than a hysterectomy and the recovery time is shorter. The operative and short-term complications of endometrial ablations are well documented; however, the delayed or long-term complications and their significance are just now being understood. Purpose and Conclusions: This review will thoroughly discuss these delayed complications. The reason these unique problems are occurring is that the ablation procedure attempts to remove all of the endometrium, which exposes myometrium. At the end of the procedure, after the distention media or instrument is removed, the myometrial walls collapse upon each other and have a natural tendency to grow together, causing intrauterine scarring and contracture. If bleeding occurs from persistent or regenerating endometrium trapped behind the scar, it can be obstructed and cause central hematometra, cornual hematometra, postablation tubal sterilization syndrome, retrograde bleeding, and potentially delay the diagnosis of endometrial cancer. From a practical standpoint, it is problematic when a postablation patient returns with abnormal or postmenopausal bleeding. Scarring makes thorough evaluation of the intrauterine cavity difficult. Endometrial biopsies, which are a simple office diagnostic procedure, are no longer reliable. An ultrasound guided hysteroscopy is usually indicted but can be unsuccessful in getting to the tissue because of dense intrauterine scarring that can distort the intrauterine architecture. Even if tissue is obtained, it is difficult to ascertain if it is a complete sample. This is a challenging situation because a hysterectomy is often necessary just to resolve the problem.