Prediction of Treatment Outcomes After Global Endometrial Ablation
To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models.
Journal of Obstetrics & Gynecology - January 2009
Reprinted with permission
OBJECTIVE:
To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models.
METHODS:
From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radio frequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation).Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure.Treatment failure was defined as hysterectomy or reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes.
RESULTS:
The amenorrhea rate was 23% (95% confidence interval [CI] 19-28%) and the 5-year cumulative failure rate was 16% (95% CI 10-20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR] 2.6, 95% CI 1.6-4.3); uterine length less than 9 cm (aOR 1.8, 95% CI 1.1-3.1); endometrial thickness less than 4 mm (aOR 2.7, 95% CI 1.2-6.3); and use of radio-frequency ablation instead of thermal balloon ablation (aOR 2.8, 95% CI 1.7-4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR] 2.6, 95% CI 1.3-5.1); parity of 5 or greater (aHR 6.0, 95% CI 2.5-14.8); prior tubal ligation (aHR 2.2, 95% CI 1.2-4.0); and history of dysmenorrhea (aHR 3.7, 95% CI 1.6-8.5). After global endometrial ablation, 23 women (5.1%, 95% CI 3.2-7.5%) had pelvic pain, three (0.7%, 95% CI 0.1-1.9%) were pregnant, and none (95% CI 0-0.8%) had endometrial cancer.
CONCLUSION:
Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal preprocedural patient counseling.
LEVEL OF EVIDENCE: II
Study shows a healthy prenatal diet could be upstream obesity prevention strategy
December 26th 2024"Our findings support the recommendation of a healthy diet based on the current guidelines (as measured by the HEI) during pregnancy, since it may reduce patterns of infant growth outside reference ranges."
Read More
Recap on reproductive rights with David Hackney, MD, MS
December 20th 2022In this episode of Pap Talk, we spoke with David Hackney, MD, MS, maternal-fetal medicine physician at Case Western Reserve University and chair of ACOG's Ohio chapter for a full recap of where restrictions on reproductive rights have been and where they're going.
Listen
Addressing mental health risks in endometriosis patients
December 10th 2024A new study underscores the critical need for gynecologists and mental health professionals to collaborate in managing anxiety, depression, and sexual dysfunction in women with endometriosis, driven by chronic pain and related comorbidities.
Read More
In this episode of Pap Talk, Gloria Bachmann, MD, MSc, breaks down what it means to be a health care provider for incarcerated individuals, and explores the specific challenges women and their providers face during and after incarceration. Joined by sexual health expert Michael Krychman, MD, Bachmann also discusses trauma-informed care and how providers can get informed.
Listen
IUD placement within 48 hours nonsuperior vs 2 to 4 weeks after abortion
November 19th 2024A study reveals no significant difference in 6-month intrauterine device use between placements within 48 hours or 2 to 4 weeks after a second-trimester abortion, though earlier placement carries a higher expulsion risk.
Read More
