Long-Term outcomes after endometrial Ablation: A case series at the medical University Innsbruck

OBJECTIVE: To evaluate the long-term effectiveness and patient satisfaction following endometrial ablation for abnormal uterine bleeding (AUB), with a focus on radiofrequency ablation. METHODS: This retrospective cross-sectional single-center study aims to assess the efficacy and patient satisfaction after endometrial ablation. We analyzed data from 1,757 patients treated for AUB at the Medical University of Innsbruck between 2004 and 2022, including 609 patients who underwent radiofrequency ablation (NovaSure) between 2014 and 2018. Patient-reported outcome were evaluated through standardized telephone interviews. RESULTS: NovaSure was the most commonly used method (63%, 1115/1757), followed by ThermaChoice balloon ablation (29%, 512/1757) and hydrothermoablation (1.6%, 29/1757). The median patient age was recorded as 46 years. Hysterectomy was required in 13% (229/1757) of cases, of which 6.9% (122/229) were due to persistent or recurrent AUB, while 6.1% (107/229) were performed for unrelated indications, including uterine prolapse, adnexal cysts, or endometrial hyperplasia/neoplasia. Among 431 patients with long-term check-up, 90% reported satisfaction, 64% (276/431) achieved amenorrhea, while 83% (358/431) required no further surgery. In multivariate analysis, increasing age was associated with a lower risk of hysterectomy (OR 0.97, p = 0.025) but a higher risk of treatment failure (OR 1.06, p = 0.016). Outcomes were mainly influenced by fibroid-related bleeding, with overall results confirming sustained bleeding reduction and high patient satisfaction. CONCLUSION: Endometrial ablation is a highly effective and well-tolerated treatment for AUB, achieving high patient satisfaction and significant bleeding reduction over a long-term period. Careful patient selection and preoperative assessment are crucial to optimizing outcomes and minimizing the need for secondary interventions.