Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study

ObjectiveTo assess the risk of further surgery amongst women who had an initial endometrial ablation (EA) for the treatment of heavy menstrual bleeding (HMB). DesignA retrospective cohort study using a national administrative database. SettingPopulation-based study of hospital care in the English National Health Service. PopulationA cohort of 114910 women who had EA for HMB between January 2000 and December 2011. MethodsMultiple Cox regressions were performed to identify the risks of a further procedure, adjusted for age, social deprivation, year and type of initial EA, and presence of fibroids/polyps. Main outcome measuresTime to repeat EA or hysterectomy after initial surgery. ResultsOf 114910 women undergoing EA, 16.7% had at least one subsequent procedure within 5years. Higher rates of subsequent surgery were associated with younger age at initial EA, with women aged under 35years having an adjusted hazard ratio of 2.83 (95% CI 2.67-2.99), compared with women aged over 45years. Women who had radiofrequency ablation were less likely to have subsequent surgery as compared with first-generation techniques (HR 0.69, 95% CI 0.63-0.76). The rate of a subsequent hysterectomy within 5years was 13.5%. Younger women (OR 0.59, 95% CI 0.51-0.69) and those who had balloon, microwave, or radiofrequency ablation were less likely to have a second EA procedure, rather than a hysterectomy. ConclusionsOne in six women have further surgery after EA for HMB, which is a higher rate than reported in clinical trials. This risk of further surgery decreases with age.