ENDOMETRIAL ABLATION - POSTOPERATIVE PAIN, SONOGRAPHIC FINDINGS, MANAGEMENT AND OUTCOME

Eighteen patients who underwent endometrial ablation between December 1987 and September 1992, reported continued pain and were placed in a study group. All patients had a pre-operative diagnosis of menorrhagia unresponsive to conventional therapy. Most ablations were performed u sing a continuous flow 25 F resectoscope. Each patient had at least on e post-operative sonogram. Patients have been followed for a minimum o f 6 months (range 6-48). Nine patients also reported vaginal bleeding. By ultrasound, eight patients were shown to have developed small cyst ic areas within the myometrium; all were ultimately confirmed with a m icroscopic diagnosis of adenomyosis. Three patients had haematometra, five had residual endometrial tissue, and two were unremarkable. Eight patients have undergone hysterectomy (five of whom had failed repeat ablation), six have been managed with repeat ablation and four are bei ng managed conservatively with medication and physical examination. Pr eliminary findings suggest that intractable pain following endometrial ablation is a poor prognostic indicator. Most patients fail to improv e following a repeat ablation and ultimately require hysterectomy.