Prognostic parameters for endometrial ablation
Although endometrial resection or ablation seems to be an effective procedure with high success rates for individual patients, it is recognized that there are certain prognostic parameters which would help to predict outcomes in counselling patients.
One should consider pre-existing conditions when counselling patients regarding outcome expectations after an endometrial ablation procedure.Table 48.2 shows the prognostic factors that have been evaluated and those that were just poorly or never evaluated.
• Adenomyosis: adenomyosis is still not easily diagnosed before treatment but it is related to failure after endometrial ablation (33).
• Sterilization: if the patient was sterilized before endometrial ablation was performed, a higher chance of failure was found (34, 35).
Table 48.2 Prognostic factors that have been evaluated and those that were just poorly or never (PBAC) evaluated for endometrial ablation
| Evaluated prognostic values | I Poor evaluated values |
| Sterilization Age BMI Cavity length (sound length) Myomas Smoking Parity Preoperative dysmenorrhoea | PBAC Endometrial thickness Adenomyosis |
PBAC, Pictorial Blood Loss Assessment Chart.
In all the trials laparoscopic sterilization was performed and there is little known about the effects of hysteroscopic sterilization.
• Age: older age seems to be prognostically favourable for success after endometrial ablation (36-39). Cut- offin the trials was mostly more than 45 years of age.
• Body mass index (BMI): when a woman has a high BMI there is a higher ability for the regeneration of endometrial tissue.
• Cavity length: the longer the cavity length, the more unfavourable the outcomes after ablation (34).
• Smoking: tobacco gives inferior results after endometrial ablation; the relationship between smoking and endometrial ablation is unclear.
• Fibroids: the existence of myomas in the uterus is prognostically unfavourable; the existence of submucous fibroids seems to be correlated with a higher chance of dissatisfaction after endometrial ablation (34, 40).
• Parity: parity of more than five deliveries has a higher chance of reintervention (36, 37).
• Preoperative dysmenorrhoea: the observed instance of failure or reintervention after endometrial ablation is more frequently observed in women with preablation dysmenorrhoea (34, 3638, 40, 41).