title: Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction: A Cohort Study.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of endometrial ablation (EA) for the treatment of abnormal uterine bleeding (AUB) associated with ovulatory dysfunction.
  
  
  METHODS
  A retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  An academic medical center.
  
  
  METHODS
  Women with AUB who underwent EA during an 8-year period.
  
  
  METHODS
  EA by radiofrequency or thermal balloon ablation techniques.
  
  
  RESULTS
  Women with AUB were divided into 2 groups: irregular bleeding with ovulatory dysfunction (AUB-O) or regular heavy bleeding related to a primary endometrial disorder (AUB-E). Outcome measures included rates of amenorrhea and treatment failure (ie, need for reablation or hysterectomy). Outcomes were compared between groups using survival analyses and chi-square tests. Known confounders were adjusted for using Cox and logistic regression models. Five-year cumulative treatment failure rates were 11.7% (95% confidence interval [CI], 6.5%-16.9%) for AUB-O and 12.3% (95% CI, 8.4%-16.2%) for AUB-E (p = .62). The unadjusted hazard ratio for treatment failure was 0.87 (95% CI, 0.72-1.05, p = .16). After adjusting for known risk factors for failure, the hazard ratio was 1.48 (95% CI, 0.82-2.65, p = .19). The rates of amenorrhea were 11.8% for AUB-O and 13.8% for AUB-E with an unadjusted odds ratio of 0.84 (95% CI, 0.48-1.48, p = .55). After adjusting for factors for amenorrhea after EA, the odds ratio was 1.08 (95% CI, 0.62-1.84, p =.78). No pregnancies or endometrial cancers occurred after EA.
  
  
  CONCLUSIONS
  EA is effective in women with AUB-O and can be used as an alternative to hysterectomy or in patients with contraindications to medical management of AUB-O.
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alexis N
authors.initials: AN
authors.lastname: Hokenstad
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Zaraq
authors.initials: Z
authors.lastname: Khan
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Electronic address: famuyide.abimbola@mayo.edu.
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000209:etiology / Q000601:surgery*; D004412:Dysmenorrhea / Q000209:etiology / Q000601:surgery*; D055356:Endometrial Ablation Techniques / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D015994:Incidence; D016015:Logistic Models; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D010049:Ovarian Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D010060:Ovulation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery
keywords: Abnormal uterine bleeding; Endometrial ablation; Irregular bleeding