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 radiofrequency 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 re-ablation 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 radiofrequency 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, 3 (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.

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BACKGROUND: Most endometrial cancer cases are preceded by abnormal uterine bleeding, offering a potential opportunity for early detection and cure of endometrial cancer. Although clinical guidelines exist for diagnostic workup of abnormal uterine bleeding, consensus is lacking regarding optimal management for women with abnormal bleeding to diagnose endometrial cancer. OBJECTIVE: We report the baseline data from a prospective clinical cohort study of women referred for endometrial evaluation at the Mayo Clinic, designed to evaluate risk stratification in women at increased risk for endometrial cancer. Here, we introduce a risk-based approach to evaluate diagnostic tests and clinical management algorithms in a population of women with abnormal bleeding undergoing endometrial evaluation at the Mayo Clinic. STUDY DESIGN: A total of 1163 women aged 45 years were enrolled from February 2013 to May 2019. We evaluated baseline absolute risks and 95% confidence intervals of endometrial cancer and endometrial intraepithelial neoplasia according to clinical algorithms for diagnostic workup of women with postmenopausal bleeding (assessment of initial vs recurrent bleeding episode and endometrial thickness measured through transvaginal ultrasound). We also evaluated risks among women with postmenopausal bleeding according to baseline age (<60 vs 60þ years) as an alternative example. For this approach, biopsy would be conducted for all women aged 60þ years and those aged <60 years with an endometrial thickness of >4 mm. We assessed the clinical efficiency of each strategy by estimating the percentage of women who would be referred for endometrial biopsy, the percentage of cases detected and missed, and the ratio of biopsies per case detected. RESULTS: Among the 593 women with postmenopausal bleeding, 18 (3.0%) had endometrial intraepithelial neoplasia, and 47 (7.9%) had endometrial cancer, and among the 570 premenopausal women with abnormal bleeding, 8 (1.4%) had endometrial intraepithelial neoplasia, and 7 (1.2%) had endometrial cancer. Maximum risk was noted in women aged 60þ years (17.7%; 13.0%e22.3%), followed by those with recurrent bleeding (14.7%; 11.0%e18.3%). Among women with an initial bleeding episode for whom transvaginal ultrasound was recommended, endometrial thickness did not provide meaningful risk stratification: risks of endometrial cancer and endometrial intraepithelial neoplasia were nearly identical in women with an endometrial thickness of >4 mm (5.8%; 1.3%e10.3%) and 4 mm (3.6%; 0.9%e8.6%). In contrast, among those aged <60 years with an endometrial thickness of >4 mm, the risk of endometrial cancer and endometrial intraepithelial neoplasia was 8.4% (4.3% e12.5%), and in those with an endometrial thickness of 4 mm, the risk was 0% (0.0%e3.0%; P¼.01). The most efficient strategy was to perform biopsy in all women aged 60þ years and among those aged <60 years with an endometrial thickness of >4 mm, with the lowest percentage referred to biopsy while still detecting all cases. CONCLUSION: Existing clinic...

Loop electrosurgical excision procedure is an acceptable alternative to CKC in women with CIN and unsatisfactory colposcopic examinations. Close follow-up is necessary for prompt detection and treatment of persistent or recurrent disease.

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Objective To determine the reproducibility of classifying uterine fibroid using the 2011 International Federation of Gynecology and Obstetrics (FIGO) staging system. Methods The present retrospective cohort study included patients presenting for the treatment of symptomatic uterine fibroids at the Gynecology Fibroid Clinic at Mayo Clinic, Rochester, USA, between April 1, 2013 and April 1, 2014. Magnetic resonance imaging of fibroid uteri was performed and the images were independently reviewed by two academic gynecologists and two radiologists specializing in fibroid care. Fibroid classifications assigned by each physician were compared and the significance of the variations was graded by whether they would affect surgical planning. Results There were 42 fibroids from 23 patients; only 6 (14%) fibroids had unanimous classification agreement. The majority (36 [86%]) had at least two unique answers and 4 (10%) fibroids had four unique classifications. Staging variation was not associated with physician specialty. More than one-third of the classification discrepancies would have impacted surgical planning. Conclusion FIGO fibroid classification was not consistent among four fibroid specialists. The variation was clinically significant for 36% of the fibroids. Additional validation of the FIGO fibroid classification system is needed.