WASHINGTON — Endometrial ablation is safe and effective in adolescents who have intractable menorrhagia and for whom future fertility is not a concern, Jon I. Einarsson, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.
Endometrial ablation for menorrhagia is usually reserved for women who do not desire pregnancy and is used in younger women only when their bleeding is life-threatening, said Dr. Einarsson of Baylor College of Medicine, Houston.
He reviewed the experience at his institution in six adolescents with concomitant severe disorders that ruled out future fertility. These included severe mental retardation, vasculitis, paraplegia, cerebral palsy, and seizure disorder. All patients had failed to respond to nonsurgical therapy.
The patients' mean age at the time of the procedure was 15.6 years. The initial success rate was 66.7% (four out of six).
One patient in whom ablation failed was found to have an arcuate uterus and subsequently underwent hysterectomy. The second patient, found to have a septate uterus, was successfully treated with a second ablation procedure when the uterine horns were more completely accessed.
After treatment, the patients' use of menstrual pads decreased from a mean of 7.7 per day to 1.3 per day. Mean duration of menses decreased from 7.2 days to 1.5 days. When contacted an average of 32 months after the ablation, “all patients and/or guardians were satisfied with the treatment outcome and would recommend the procedure to others,” Dr. Einarsson said in a poster presentation at the meeting.
“The use of uterine balloon therapy is especially attractive in teenagers, because the 5-mm device requires minimal cervical dilatation, a procedure that can be challenging in an adolescent nulliparous cervix,” he noted.
In addition, the approach is particularly useful because patients typically undergo preablation diagnostic hysteroscopy that allows “identification of possible uterine anomalies that might interfere with the performance of the thermal balloon.”