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Iatrogenic disease
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
Endometrial ablation is an accepted alternative to hysterectomy in women with abnormal uterine bleeding whose symptoms have not responded to conservative management and who have no underlying uterine pathology. Endometrial ablation aims to destroy the endometrium and may be resectoscopic, such as laser ablation and electrosurgical resection, or nonresectoscopic, using a variety of energy sources to nonselectively destroy the endometrial lining.36 Irrespective of the modality used for ablation, the post-ablation endometrium shows a range of abnormalities comprising necrosis, inflammation, foreign body giant cells, necrobiotic granulomas and fibrosis.37 In the first three months following ablation, there is acute inflammation, necrosis, foreign body giant cells and a granulomatous response to necrotic tissue (Figures 6.35 and 6.36). The foreign body giant cells contain brown and black pigmented material (Figure 6.37). The necrobiotic granulomas are microscopically similar to rheumatoid nodules; they comprise a central zone of amorphous eosinophilic necrotic tissue surrounded by palisaded macrophages and an outer layer of fibrous tissue infiltrated by chronic inflammatory cells (Figures 6.38 and 6.39). Necrosis becomes less evident after the first few months, but the granulomatous response may persist and fibrosis develops. The fibrosis may extend into the myometrium and may be admixed with pigment-containing foreign body giant cells. Eventually the endometrial cavity may fuse either partially or completely (Figure 6.40).
Gynaecology
Published in Andrew Stevens, James Raftery, Gynaecology Health Care Needs Assessment, 2018
Endometrial ablation can be performed by transcervical resection of the endometrium (TCRE), coagulation with a rollerball electrode, laser ablation or radiofrequency-induced thermal ablation. With laser ablation most patients are discharged after an overnight stay in hospital and return to full activities within ten days.191 Rollerball coagulation takes about 25 minutes and most patients return to full activity within one week, with 30–40% of women becoming amenorrhoeic and 55–60% having reduced menstrual flows which is similar to the results of laser ablation and radiofrequency-induced thermal ablation.191–193
Contraception
Published in Elaine Cooper, John Guillebaud, Morgan Williams, Sexuality and Disability, 2017
Elaine Cooper, John Guillebaud, Morgan Williams
Women need to consider that being sterilised will stop concerns about becoming pregnant but will not have any effect on menstruation. Indeed, if a woman has been using hormonal contraception to abolish or control blood loss, she will need to continue taking these drugs after the operation or cope with menstruation again. It was hoped that endometrial ablation would be valuable in this context. Endometrial ablation in itself cannot be considered to be contraceptively safe, but in conjunction with sterilisation would be effective. However, the incidence of bleeding following endometrial ablation can be a problem, as it is difficult to ensure that every fragment of endometrium is ablated. Those that remain may bleed.
Re-intervention and patient satisfaction rates following office radiofrequency endometrial ablation: a comparative retrospective study of 408 cases
Published in Journal of Obstetrics and Gynaecology, 2022
Ahmed Ghoubara, Seuvandhi Gunasekera, Lavanya Rao, Ayman Ewies
The relationships between younger age and increased risk of surgical re-intervention were reported in several studies. In the previously mentioned Longinotti et al study, Cox regression analysis found that compared with women >45 years, those ≤45 years were 2.1 times more likely to have a hysterectomy (95% CI 1.8 − 2.4, p < .001). Hysterectomy risk increased with each decreasing stratum of age exceeding 40% in women aged ≤40 years and rather than plateauing within several years of endometrial ablation, it continues to increase through 8 years of follow-up (Longinotti et al. 2008). Furthermore, Bansi-Matharu et al. found that age remained the strongest predictor of subsequent hysterectomy after ablation when other risk factors were taken into account in the multiple Cox regression model. The proportion of women aged ≤35 years who had a hysterectomy within 5 years was 26.9%, compared with 10.4% of those aged ≥45 years (p < .001) (Bansi-Matharu et al. 2013). In this study, age had no significant effect on the rate of surgical re-intervention possibly because of the relatively high median age of the cohort (44 years, IQR = 41 − 48). This might be considered as good practice since delaying the initial endometrial ablation, with prior exhaustion of all medical options, reduces the need for surgical re-intervention. At the same time, the individual woman’s choice should be respected after providing information as regards the re-intervention rate during the consent process.
Clinical evaluation of HIFU combined with GnRH-a and LNG-IUS for adenomyosis patients who failed to respond to drug therapies: two-year follow-up results
Published in International Journal of Hyperthermia, 2021
Yan Peng, Yu Dai, Guiyuan Yu, Xiaorong Yang, Cuili Wen, Ping Jin
The greater the NPV ratio, the longer the long-term symptom relief sustained [24]. Because of the unclear boundary of adenomyotic lesion, the focal point was at least 1.5 cm away from the margin of the uterus in order to ablate more lesions near the uterine serosa and to prevent intestinal injury at the same time. As the 47 patients had no fertility desires, the endometrium near adenomyotic lesions was also ablated during HIFU treatment in order to ablate more lesions and to improve the NPV ratio. In this study, the mean NPV ratio was 82.81% after HIFU. Meanwhile, endometrial ablation may help reduce menstrual volume. Scanty vaginal bleeding occurred within one month after HIFU treatment in all patients because of the endometrial ablation near adenomyosis lesions. No major post-HIFU complications were observed in this cohort. Previous studies showed a sufficient superior effect of endometrial ablation combined with LNG-IUS in women with adenomyosis [25]. In this study, the ablation of the endometrium near adenomyotic lesions may help to increase the effects of HIFU treatment combined with GnRH-a and LNG-IUS and reduce the expulsion rate of LNG-IUS, which need further research to confirm.
Reframing “The Patient's Best Interest”: The Burden of The Caregiver
Published in The American Journal of Bioethics, 2018
Rebecca Lunstroth, Rhashedah Ekeoduru
There are two surgical options available. The first is endometrial ablation. This is where the lining of the uterus is removed using heat or microwaves. It is the safer of the two surgical options for menorrhagia not caused by uterine fibroids, which the patient in this case does not have. Endometrial ablation can reduce heavy bleeding in approximately 85% of women, but does not result 100% of the time in cessation of bleeding or improvement of symptoms. Furthermore, for some women, heavy bleeding may resume over time if the endometrium regenerates. This is more common in younger women, such as our patient. Endometrial ablation is complicated in 1 of every 1000 procedures, with risks including infection, accidental damage to the bowel, potential damage to the uterus, blockage of arterial blood flow to the lung (pulmonary embolism), buildup of fluid in the lungs (pulmonary edema), and tearing of the cervix (Shaw 2017). Furthermore, pregnancy can still occur, and if it does, severe complications are likely.