Endometrial ablations were first introduced as a surgical treatment for heavy menstrual bleeding (HMB) in 1886.1 Starting in the 1980s, global endometrial ablation (GEA) emerged as a less invasive and more convenient methodology to reduce excessive bleeding and painful menstrual cramping.2 As GEA technology continued to evolve, especially with heat-based techniques, many OBGYNs shifted their focus to amenorrhea as the optimal treatment outcome.3 However, gynecologists must understand their patient goals and preferences, as well as clinical data, when determining an appropriate treatment plan.
In addition to maintaining patient safety, the most important consideration gynecologists should account for when selecting HMB treatment is how to stay aligned with each individual’s goals and preferences. For many patients, this does not include amenorrhea. According to market research, 86% of women with HMB would characterize treatment success as a normal or better period.4 While endometrial ablation treatment should aim to reduce HMB to eumenorrhea or hypomenorrhea, the focus should primarily be on improving quality of life. Patients may wish to have a lighter or normal period for several reasons, including:5
On top of understanding patient goals and preferences, gynecologists should clearly communicate what results patients should expect after endometrial ablation — namely, normal or lighter periods and less cramping. According to ACOG Practice Bulletin 81, although possible, amenorrhea is not the primary outcome of ablation.6 In fact, only up to 47% of procedures induce long-term amenorrhea, with many techniques generating much lower rates on average.7
The only way to guarantee amenorrhea is by excising the uterus altogether. If patients are looking to stop their periods, then a hysterectomy should be discussed as a definitive treatment option. Setting appropriate expectations for HMB treatment options, including endometrial ablations, should ensure that patients feel confident in the procedural efficacy and satisfied with their results.
Instead of eliminating periods altogether, the focus should shift to a holistic treatment approach that specifically addresses the HMB symptoms impacting quality of life. Dysmenorrhea is often a chief complaint among women with menorrhagia; one systematic review and meta-analysis calculated a 71.1% prevalence rate of dysmenorrhea on a global scale.8 Severe pelvic cramping not only prevents patients from engaging in social activities, work, and school, but also reduces quality of life and significantly increases the risk of depression and anxiety.9
To best meet patient needs, gynecologists can utilize cryotherapy during endometrial ablation to deliver the dysmenorrhea relief their patients are looking for, while also reducing menstrual bleeding to normal levels or often better. The Cerene® Cryotherapy Device provides a safe, effective, and well-tolerated endometrial cryoablation procedure that not only helps 90% of patients return to normal, light, or no periods†, but also generates a significant reduction in dysmenorrhea — 86% of patients treated with Cerene experience a significant reduction in severe menstrual cramping following the procedure.‡
In addition to considering how each GEA modality impacts short-term outcomes, gynecologists should also consider long-term health and clinical options. Uterine cavity access should be considered a primary treatment outcome, as cavity visualization is crucial for future diagnostic evaluation for abnormal uterine bleeding. Postablative scarring can delay the diagnosis of endometrial cancer, as endometrial assessments, including endometrial biopsy and sonohysterography, are difficult to perform with intrauterine adhesions following thermal ablation.11.12 Additionally, intrauterine surgical trauma increases the risk of developing synechiae which, in turn, can generate post-ablation cyclic pelvic pain (CPP) and lead to postablation tubal sterilization syndrome (PATSS) in up to 10% of cases.13-15
These long-term ablation complications can be mitigated if patients are treated with cryotherapy. By resulting in minimal postablation intrauterine scarring and adhesion formation, Cerene provides full cavity access in 96% of patients and has no reported signs or symptoms of PATSS 12 months after treatment.16,17
Prioritizing a patient’s best interest both now and in the future means choosing a treatment modality that prevents unnecessary pain and unintended clinical consequences. With Cerene, you can deliver an endometrial ablation treatment that helps your patients achieve a higher quality of life and find long-term relief from painful, heavy periods.
Learn more at https://cerene.com/healthcare-professionals/
† Patient-reported data are 1 year after treatment with durable results at 3 years
‡ Improvement reported one year after treatment for patients reporting severe/very severe period pain
Important Safety Information
Cerene® Cryotherapy Device is indicated to ablate the endometrial lining of the uterus in premenopausal women with heavy menstrual bleeding due to benign causes for whom childbearing is complete. Pregnancy following the Cerene procedure can be dangerous; therefore, contraception must be used until menopause. The Cerene procedure is not for those who have or suspect uterine cancer; have an active genital, urinary or pelvic infection; or an IUD. As with all surgical procedures, there are risks and considerations associated with the use of the Cerene Cryotherapy Device. Temporary side effects may include cramping, nausea, vomiting, vaginal discharge and spotting. For detailed benefit and risk information, consult the Cerene Instructions for use (IFU) or your healthcare professional. Learn More