PATSS and Endometrial Ablation: Breaking the Cycle

Endometrial ablation is a safe and effective treatment option for many women with menorrhagia, also referred to as heavy menstrual bleeding (HMB), but certain factors can impact ablation outcomes and lead to more invasive treatments in the future. Historically, prior bilateral tubal ligation is a primary factor that should be considered before recommending a patient for ablation due to the potentially negative outcomes of destroying tissue near the obstructed tubes.¹ Without careful examination and proper ablation technique, these patients are at risk for developing post-ablation tubal sterilization syndrome (PATSS).

Endometrial Ablation and PATSS: An Overview

PATSS is characterized by significant and debilitating cyclic pelvic pain following endometrial ablation.² The connection between ablation and PATSS can be difficult to identify and diagnose, but this complication most likely occurs due to:^2,3

• Occult bleeding in the obstructed tubes
• Endometrial regrowth and distension in the tubes
• Retrograde menstruation into the tubes

For women suffering from menorrhagia, PATSS indicates a failed ablation due to the recurring pain that the procedure aimed to mitigate. PATSS is known to occur in an estimated 10% of endometrial ablations; however, the risk of developing PATSS may be dependent on the method of ablation.¹ Because this complication is often caused by non-uniform tissue destruction and a more extensive healing response, a link can be made between PATSS and most heat-based ablation techniques, as OBGYNs who perform thermal tissue destruction often rely on scarring and adhesion formation to determine whether the treatment was successful.⁴ However, excessive scarring can give rise to delayed complications like PATSS that interfere with treatment efficacy and force patients to resort to hysterectomy.

Cryotherapy: Clinically Proven to Minimize the Risk of PATSS

To break the cycle between endometrial ablation and PATSS, gynecologists can adapt their treatment approach in a two-fold process. First, patient eligibility must be evaluated before selecting ablation as the ideal treatment. If ablation is determined to be the best treatment for a patient with prior tubal ligation, the second step is selecting a technique that lowers the risk of PATSS and other challenges associated with traditional thermal methods. Cryotherapy offers these benefits by inducing a different post-ablation healing response that freezes and dehydrates endometrial cells, instead of charring tissue and forming intrauterine synechiae that can lead to delayed complications.

The Cerene® Cryotherapy Device represents the latest innovation in cryotherapy, deploying nitrous oxide in a cavity-conforming liner to freeze the endometrium, delivering a uniform, effective, and well-tolerated ablation treatment. Endometrial cryoablation with Cerene is clinically proven to achieve normal, light, or no periods in 90% of patients^† and relieve dysmenorrhea for 86% of patients.^‡ Moreover, Cerene is also clinically proven to result in minimal scarring and adhesion formation, including patients with prior tubal ligation. As a result, 12 months after treatment, patients treated with Cerene have zero signs or symptoms of PATSS, with 96% of patients in the same study maintaining full cavity access for future pathologic evaluation.⁵ 

With Cerene, OBGYNs can deliver an endometrial ablation treatment that is both safe and effective for patients who have undergone tubal ligation. Learn more about how Cerene cryotherapy can reduce the risk of PATSS for your patients 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 is safe and effective for many women with HMB, but patients with prior tubal ligation have historically been at risk of developing PATSS.
• Heat-based endometrial ablations are linked to PATSS due to thermal tissue destruction near the obstructed tubes, which can lead to debilitating cyclic pelvic pain.
• Cryotherapy with Cerene ablates the endometrium with a freezing agent, inducing a different healing response that results in minimal scarring and lowers the risk of PATSS.

Sources

1. Akinlaja, O. & Sherrow, S. (2014). Postablation Tubal Sterilization Syndrome. Austin Journal of Obstetrics and Gynecology 1(1), 2.
2. Minalt, N. Canela, C.D., Marino, S. (2022, December 19). Endometrial Ablation. In StatPearls. StatPearls Publishing. Retrieved May 20, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK459245/ 
3. Tam, T., Elgar, C., Jirschele, K., Lombard, E. (2012). Post-ablation tubal sterilization syndrome following NovaSure endometrial ablation: two case reports. Gynecological Surgery 9, 449-452.
4. Wortman M. (2017). Late-onset endometrial ablation failure. Case reports in women’s health, 15, 11–28. 
5. 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.