Postablation risk factors for pain and subsequent hysterectomy

OBJECTIVE: To assess patient characteristics associated with pain and hysterectomy after endometrial ablation. METHODS: A retrospective cohort study was performed using data from two large academic medical centers. Three hundred patients who underwent endometrial ablation between January 2006 and May 2013 were identified for study. Data collected included baseline characteristics at the time of ablation, relevant medical history, and ablation technique. Univariate tests of association and logistic regression were used to evaluate risk factors for postablation pain or hysterectomy. RESULTS: Of the 300 women who had endometrial ablation performed during the study period, 270 had follow-up data for analysis. Twenty-three percent developed new or worsening pain after ablation and 19% underwent a hysterectomy. A history of dysmenorrhea gave a 74% higher risk of developing pain (adjusted odds ratio [OR] 1.74, 95% confidence interval [CI] 1.06-2.87) and tubal sterilization conferred more than double the risk (adjusted OR 2.06, 95% CI 1.14-3.70). Women of white race were 45% less likely to develop pain (adjusted OR 0.55, 95% CI 0.34-0.89). For hysterectomy, a history of cesarean delivery more than doubled the risk (adjusted OR 2.33, 95% CI 1.05-5.16), whereas uterine abnormalities on imaging, including leiomyoma, adenomyosis, thickened endometrial strip, and polyps, quadrupled the risk (adjusted OR 3.96, 95% CI 1.25-12.56). A procedure performed in the operating room decreased the risk of hysterectomy by 76% (adjusted OR 0.24, 95% CI 0.07-0.77). Hysterectomies for the indication of pain occurred more than 3 years sooner than for other indications (P<.001). CONCLUSION: Patient characteristics should be considered when counseling patients about the possible outcomes of endometrial ablation. A significant portion of ablations are complicated by postablation pain.