Case Study: Sonohysterography and Biopsy of Uterine Cavity After Endometrial Cryoablation with Cerene

Endometrial ablations have a proven track record of reducing bleeding and improving quality of life for patients with heavy menstrual bleeding.¹ Unfortunately, ablation technology can have drawbacks for patients.

Thermal ablations can cause intrauterine scarring during the healing process, which can prevent physicians from performing future diagnostic hysteroscopies and other procedures that require cavity access.²

Cryoablation, on the other hand, can open the door to more care options thanks to its ability to preserve cavity access. Here we explore how the Cerene^® Cryotherapy Device helped one OBGYN discover a diagnosis that may not have been possible following a thermal ablation—and put his patient on the road to treatment.

Patient Demographics and Medical History

The patient (age 43, BMI 40) had a long history of menorrhagia, as well as a history of depression and anxiety. She had two endometrial biopsies in 2023 and 2024 that had returned unremarkable, without any intercavitary concerns.

The patient had tried hormone therapy to treat her menorrhagia in the past, but to little success. She had not pursued any other course of treatment.

Cerene Treatment

In preparation for a cross-country move, the patient requested an ablation to treat her menorrhagia. She was referred to Dr. Dennis S. Strittmatter, Obstetrician & Gynecologist, who recommended cryoablation with Cerene.

“I’ve inherited patients who have had heat-based ablations, and on multiple occasions that has resulted in me being unable to enter the cavity to properly assess the patient,” Dr. Strittmatter explains. “I’ve never felt comfortable with that, so I only perform cryoablations at my practice,”

In June 2024 the patient received a hysteroscopy and cryoablation with the Cerene Cryotherapy Device, an FDA-approved endometrial cryoablation treatment that can safely and effectively treat heavy menstrual bleeding.

After a full resection of the endometrium*, the sampling of the lining was not found to be hyperplastic nor atypical. The results were fully benign, and the ablation procedure proceeded successfully .

Post-Treatment

The patient reported lighter menstrual flow following cryoablation with Cerene. When she returned to Dr. Strittmatter for a sonogram to evaluate ovarian cysts in March 2025, Dr. Strittmatter noted that the patient’s endometrial lining looked thickened and cystic, prompting him to perform a sonohystogram.

Unfortunately, the patient was diagnosed with complex hyperplasia with atypia. Dr. Strittmatter referred her to get a hysterectomy.

Outcomes

In cases of complex hyperplasia with atypia, patients have a remarkably high risk of cancer—or of developing cancer if not treated promptly.³ The patient’s diagnosis, and the timely recommendation for a hysterectomy, was possible thanks to the cavity access afforded by the Cerene Cryotherapy Device.

Since cryoablation is highly effective at preserving the uterine cavity, it allowed Dr. Strittmatter to easily enter the cavity to perform the sonohysterogram and biopsy. Cerene empowered Dr. Strittmatter to reassess the patient, uncover her diagnosis, and help her move forward with a plan for treatment.

“If the patient had received a heat-based ablation, it wouldn’t have allowed me to later access the cavity to perform a sonohysterogram,” stresses Dr. Strittmatter. “We wouldn’t have discovered the hyperplasia with atypia, and the cancer would have been left to grow. Cerene helped me put my patient on the path to treatment.”

Discussion

Cryoablation isn’t just about providing more comfort for the patient. Cerene can preserve the uterine cavity for greater visualization, which may allow doctors easier access and the ability to evaluate and sample pathological changes following an ablation.

The Cerene FDA pivotal clinical study (“CLARITY”), published in The Journal of Minimally Invasive Gynecology, concluded that the use of cryoablation to treat the endometrium enables the preservation of the uterine cavity, with visualization in 91% of evaluated patients.⁴ It also allowed evaluation for pathologic change in 96% of patients whose uterine cavities could be fully visualized.

This is especially critical for patients with high BMI, who are more likely to develop hyperplasia.⁵ Traditional thermal ablations can cause adhesions and scarring of the uterine lining, which can prevent doctors from easily accessing the cavity for future procedures like sonohysterograms or hysteroscopies.²

Thanks to its cryoablation technology, Cerene Cryotherapy may be an option for patients with an increased risk of hyperplasia who otherwise wouldn’t be candidates for an ablation. One simple, effective procedure can give patients more control of their treatment options and their quality of life.

Prioritize cavity access and your patients’ future diagnostic options with Cerene. See it in action.

Disclaimer:

As always, use your medical judgement and follow any recommendations/guidelines when considering appropriate treatment for your patients

*Safety and effectiveness of the Cerene procedure following mechanical pretreatment has not been evaluated.

Sources:

1. Morris Wortman. Late-onset endometrial ablation failure. Case Reports in Women’s Health. Volume 15, 2017, Pages 11-28. ISSN 2214-9112, https://doi.org/10.1016/j.crwh.2017.07.001.
2. McCausland AM, McCausland VM. Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention. J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):399-406. doi: 10.1016/j.jmig.2007.04.004. PMID: 17630156.
3. Barakat A, Ismail A, Chattopadhyay S, Davies Q. Endometrial Cancer Incidence in Patients With Atypical Endometrial Hyperplasia According to Mode of Management. Cancer Diagn Progn. 2022 Sep 3;2(5):564-568. doi: 10.21873/cdp.10143. PMID: 36060021; PMCID: PMC9425575.
4. Curlin, Howard, et al. “Hysteroscopic Access and Uterine Cavity Evaluation 12 Months Post-Endometrial Ablation with the CERENE® Cryotherapy Device.” Journal of Minimally Invasive Gynecology, 2021, https://doi.org/10.1016/j.jmig.2021.11.016.
5. Miller, C. (2017). Diagnosis and treatment of global endometrial ablation failure. MDedge ObGyn. https://www.mdedge.com/obgyn.