Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study

Abstract

Objective: To assess the risk of further surgery amongst women who had an initial endometrial ablation (EA) for the treatment of heavy menstrual bleeding (HMB).

Design: A retrospective cohort study using a national administrative database.

Setting: Population-based study of hospital care in the English National Health Service.

Population: A cohort of 114,910 women who had EA for HMB between January 2000 and December 2011.

Methods: Multiple Cox regressions were performed to identify the risks of a further procedure, adjusted for age, social deprivation, year and type of initial EA, and presence of fibroids/polyps.

Main outcome measures: Time to repeat EA or hysterectomy after initial surgery.

Results: Of 114,910 women undergoing EA, 16.7% had at least one subsequent procedure within 5 years. Higher rates of subsequent surgery were associated with younger age at initial EA, with women aged under 35 years having an adjusted hazard ratio of 2.83 (95% CI 2.67-2.99), compared with women aged over 45 years. Women who had radiofrequency ablation were less likely to have subsequent surgery as compared with first-generation techniques (HR 0.69, 95% CI 0.63-0.76). The rate of a subsequent hysterectomy within 5 years was 13.5%. Younger women (OR 0.59, 95% CI 0.51-0.69) and those who had balloon, microwave, or radiofrequency ablation were less likely to have a second EA procedure, rather than a hysterectomy.

Conclusions: One in six women have further surgery after EA for HMB, which is a higher rate than reported in clinical trials. This risk of further surgery decreases with age.

Keywords: Endometrial ablation; heavy menstrual bleeding; hysterectomy.