It’s Okay To Do Ablations Again

Historically, endometrial ablations were regarded as a popular and satisfactory treatment for heavy menstrual bleeding (HMB). At its peak, ablation volumes totaled over 500,000 procedures each year.¹ However, in recent years, endometrial ablations have fallen out of favor with certain patients and gynecologists due to unintended long-term consequences of standard ablation methods. As a result, only an estimated 250,000 ablation procedures are performed annually, with patients turning to other treatment options, such as intrauterine devices (IUDs) or hysterectomy, to address their menorrhagia symptoms.²

Diagnosing the Decrease in Endometrial Ablation Volumes

Traditional NREA (non-resectoscopic endometrial ablation) devices may be relatively safe and effective in the short term, but a closer look at the long-term side effects reveals problematic consequences that can not only reverse symptom improvement but also limit future diagnostic options. Historically, ablations have relied on endometrial scarring to achieve their desired outcomes, even going so far as using intrauterine synechiae as an intended outcome of the procedure.¹ However, when NREA methods entered the market decades ago, we did not have sufficient data available to understand the long-term impact of adhesions and scarring.

As a result, a substantial percentage of women who are treated with heat-based ablations — one study reported over one-third of these patients — experience late-onset endometrial ablation failure (LOEAF) due to the delayed complications of excessive intrauterine scarring.³ In these cases, the endometrium is either incompletely destroyed or starts to regrow underneath the scar tissue, resulting in cyclic pelvic pain (CPP), in addition to other signs of LOEAF, such as persistent vaginal bleeding and limited cavity visualization.¹ As many as 25% of women treated with ablation will ultimately need a hysterectomy, due to intolerable bleeding, CPP, and/or an inability for OBGYNs to access the cavity to diagnose potential endometrial cancer.¹

The Role of Cryotherapy in Promoting Long-Term Ablation Outcomes

The myriad challenges associated with most traditional heat-based methods have caused both patients and physicians to turn their backs on endometrial ablations. However, new innovations are changing the narrative, helping gynecologists provide the benefits of ablation without the unintended long-term consequences of thermal tissue destruction. Cryotherapy represents one of the largest evolutions in endometrial ablation technology over the past two decades, offering a safe, effective, and well-tolerated solution to comprehensively destroy the endometrium while resulting in minimal post-ablative scarring and, by extension, aiming to reduce the likelihood of LOEAF.

As a clinically proven endometrial cryoablation treatment, the Cerene^® Cryotherapy Device helps mitigate the unwanted side effects of ablation, maintaining full cavity visualization in 91% of patients one year after treatment, and a hysterectomy rate of only 3% for heavy menstrual bleeding over 3 years.⁴ In fact, based on the clinical study for Cerene, one year after treatment, investigators reported that they were able to evaluate the uterine cavity for pathologic changes in 96% of patients with accessible uterine cavities.⁴ Using a nitrous oxide ablation treatment in a highly controlled and safe procedure, Cerene administers uniform ablation that restores normal, light, or no periods in 90% of patients^† and reduces dysmenorrhea in 86% of patients.^‡

With Cerene, gynecologists can perform endometrial ablations again, with high confidence in the outcomes they achieve and peace of mind about endometrial health in years to come. Learn more about how you can provide an endometrial ablation treatment that delivers positive long-term outcomes 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

Key Takeaways:

• Endometrial ablation volumes once totaled more than 500,000 cases per year, but have since declined to approximately 250,000 procedures annually due to unintended consequences.^1,2
• Patients and gynecologists have recognized the problematic long-term side effects of most heat-based ablations, including limited cavity visibility and cyclic pelvic pain due to intrauterine synechiae.
• Cryotherapy overcomes these challenges by administering uniform ablation that achieves positive clinical outcomes without causing the excessive scarring associated with most heat-based techniques.

Sources

1. Wortman M. (2017). Late-onset endometrial ablation failure. Case reports in women’s health, 15, 11–28.
2. Medscout Database 2024. Channel Medsystems Data on File. 
3. Stevens, K.Y.R., Meulenbroeks, D., Houterman, S., Gijsen, T., Weyers, S., Schoot, B.C. (2019). Prediction of unsuccessful endometrial ablation: a retrospective study. Gynecological Surgery 16(7).
4. Curlin, H., Cholkeri-Singh, A., Leal, J. G. G., & Anderson, T. (2022). Hysteroscopic Access and Uterine Cavity Evaluation 12 Months after Endometrial Ablation with the Cerene Cryotherapy Device. Journal of Minimally Invasive Gynecology 29(3), 440-447.