Endometrial Thermal Coagulation – Degree of Uterine Fibrosis Predicts Treatment Outcome

Abstract

Objective: To study the uterine cavity after thermal endometrial destruction for the treatment of menorrhagia by means of a balloon catheter, the Cavaterm^TM system. To relate the appearance of the uterine cavity to the outcome of the treatment. Methods: Fifty-one of the first 60 women treated with balloon endometrial destruction were examined with hysteroscopy and saline infusion sonography 11–28 months after treatment. Results: Patients with minimal or no bleeding after thermal endometrial destruction had more uterine fibrosis than patients bleeding more. Conclusion: The greater the degree of fibrosis of the uterine cavity after balloon endometrial destruction by thermal coagulation, the better the effect on menorrhagia.

Ultrasonographic Features following Thermal Balloon Endometrial Ablation Therapy

“…In a study performed by Friberg et al [2], all patients had an endometrial thickness !5 mm 11-28 months after thermal endometrial destruction. In our patients, 27% of them had a double-layer endometrial thickness 15 mm which suggests that thinning of the endometrium might proceed even after 6 months have passed since the procedure.…”

“…When hysterectomy has been performed immediately after thermal balloon endometrial ablation therapy, the mean thickness of the coagulation zone has been found to be between 3.5 mm [7] and 7.6 mm [4] on light microscopy and 4-5 mm on electron microscopy [7]. Several months after thermal balloon therapy, the hysteroscopic view resembles contraction of the uterine cavity subsequent to fibrosis [2,6]. We have reported earlier [10] that thermal balloon endometrial ablation therapy induces a rise in uterine blood flow impedance, but not until 6 months after the treatment.…”

“…In our patients, 27% of them had a double-layer endometrial thickness 15 mm which suggests that thinning of the endometrium might proceed even after 6 months have passed since the procedure. Friberg et al [2] suggested that the greater the degree of fibrosis of the uterine cavity after thermal balloon therapy, the better the effect on menorrhagia. In their study, in 86% of the examinations they could not pass a hysteroscope (diameter 4.1 mm) and in 25% of the cases a saline infusion sonography catheter (diameter 2 mm) through the inner cervical os.…”

“…Thermal balloon endometrial ablation therapy has been proved to be clinically very efficient in treating heavy menstrual bleeding [1,2] and pain [1]. The success rate -defined as subjective reduction of menses to eumenorrhea or less -was up to 90% after thermal balloon endometrial ablation therapy, and it remained constant during 1 year of follow-up [1].…”

Outcome and Hemodynamic Alternation in Uterine Artery Following Hysteroscopic Roller-Ball Endometrial Ablation

“…The increased impedance is due to decreased blood flow during diastole, because ED and TAMX were decreased, whereas PS remained unchanged. Friberge & colleagues, concluded that; the greater the fibrosis of uterine cavity after ablation was associated with better prognosis [25]. Twenty-seven (27) women with either menorrhagia or endometrial hyperplasia without atypia, were randomized to receive either thermal balloon endometrial ablation therapy or medroxyprogesterone acetate by Dr I. Järvelä and colleagues [26].…”