Clinical efficacy and predictors of recurrence after hysteroscopic endometrial ablation for refractory abnormal uterine bleeding in Jinzhou, China: A retrospective cohort study

OBJECTIVES: This study aimed to evaluate the clinical efficacy of hysteroscopic endometrial ablation and identify independent predictors associated with postoperative recurrence in women with refractory abnormal uterine bleeding (AUB). METHODS: This retrospective cohort study included 273 patients with refractory AUB who underwent hysteroscopic endometrial ablation between January 2022 and December 2023, with follow-up data collected through December 2025. Clinical, imaging, and laboratory data were collected. Recurrence was defined as the reappearance of AUB within 2 years after surgery. Patients were categorized into recurrence and non-recurrence groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. A predictive model was constructed and evaluated using receiver operating characteristic curve analysis. RESULTS: The procedure showed favorable perioperative outcomes. Over 2 years, recurrence occurred in 28.2% of patients. Pictorial blood loss assessment chart scores decreased significantly, with 27.8% achieving amenorrhea and 53.5% reporting reduced bleeding. The complication rate was low (2.2%). Multivariate analysis identified diffuse adenomyosis, uterine volume, endometrial thickness, C-reactive protein (CRP), uterine cavity width, duration of AUB, and perimenopausal status as independent predictors of recurrence. The model showed good discriminative ability, with an area under the curve of 0.878 (95% confidence interval: 0.833-0.922, P < 0.001). CONCLUSION: Hysteroscopic endometrial ablation was associated with favorable perioperative outcomes. However, recurrence remains common. Several preoperative factors were independently associated with recurrence, and the proposed model might help identify patients at higher risk of recurrence after endometrial ablation.