Objective: To determine risk factors for hysterectomy, pelvic pain, and continued menorrhagia after rollerball endometrial ablation.
Methods: All women having rollerball endometrial ablations between 1990 and 2000 were sent standardized questionnaires on pre- and postablation symptoms, satisfaction with the ablation, and subsequent gynecologic surgery. Pathology reports from surgery after the ablation were reviewed when available.
Results: Two hundred forty women had a rollerball ablation during this period and 174 (72.5%) responded to the questionnaire. The average age of women at the time of the ablation was 43.1 years and the mean follow-up time since the ablation was 49 months. Seventy-four percent of women were satisfied with the ablation and 92% reported decreased or absent menstrual bleeding since the ablation. However, 13% of women reported new or worsening pelvic pain symptoms since the ablation and 21 women (12%) had a hysterectomy after the ablation for continued symptoms. A previous tubal ligation was a risk factor for having a hysterectomy (hazard ratio of 3.3, P =.03) and for having worsened pelvic pain (hazard ratio of 3.2, P =.05) after an ablation. Women who had a previous tubal ligation were more likely to use pain medications for pelvic pain after an ablation. Age over 35 at the time of the ablation was predictive of less bleeding after the ablation. Pathologic findings consistent with the postablation tubal sterilization syndrome were observed in five surgical specimens for an incidence of 6%.
Conclusion: Having a tubal ligation is a risk factor for the development of pelvic pain and for having a hysterectomy after rollerball endometrial ablation. The incidence of pathologically confirmed postablation tubal sterilization syndrome is 6%, but clinical manifestations of this syndrome may be higher. Relatively older age at the time of the ablation is associated with a higher rate of improved bleeding symptoms after ablation.