The Importance of Uterine Cavity Access After Endometrial Ablation

For patients suffering from heavy periods, or menorrhagia, there are many treatment options that can effectively reduce heavy menstrual bleeding. Many gynecologists choose to start with medication therapy, such as a hormonal birth control pill or an intrauterine device (IUD).

However, these medications may not provide enough relief for some patients, while other patients may wish to avoid hormone-based treatment altogether. In these cases, a surgical procedure, like endometrial ablation or hysterectomy, may be recommended. Endometrial ablation is often the first choice for many OBGYNs, as it is an effective procedure that is less invasive, has shorter recovery times, and is associated with fewer complications than a hysterectomy (removal of the uterus).¹ However, as with any procedure, there are always some risks involved. For endometrial ablation, one of these potential risks is limited access to the uterine cavity after treatment.

What is Uterine Cavity Access and Why is It a Concern?

“Uterine cavity access” describes how easily the inside of your uterus (cavity) can be accessed when entered from the cervix (located at the bottom of the uterus). Good cavity access helps your gynecologist fully see and evaluate the inside of your uterus in order to identify any abnormalities, namely the source of abnormal or persistent bleeding or pain/cramping. In certain cases, these symptoms could indicate a serious condition requiring immediate attention.²

In addition to visibility, cavity access is a critical part of many diagnostic and treatment options, such as an endometrial biopsy, hysteroscopy (a thin lighted tube is used to examine the cavity), dilation and curettage (D&C; uterine lining is scraped out), and other exams to assess the uterus and ovaries.³ 

The Relationship Between Endometrial Ablation and Cavity Access

Endometrial ablation can be performed with a variety of techniques that use heat or cold technology to destroy the tissue lining the uterus (endometrium). This procedure is a great option for women living with heavy periods and debilitating pain, but one of the risks commonly associated with most heat-based ablation methods is limited uterine cavity access after treatment.⁴ 

Because the ablation procedure destroys the endometrium, the body will naturally form some scar tissue during the healing process. This scarring is commonly seen in heat-based methods that rely on burning and/or charring the tissue. As a result, gynecologists can experience difficulties navigating the uterus when the cavity contains adhesions and large formations of scar tissue. Additionally, post-ablation scarring and adhesions can lead to severe cramping and pelvic pain, otherwise known as Asherman’s syndrome.⁵ This may ultimately result in a hysterectomy if the uterus cannot be properly evaluated, treated or continues to cause significant pain. 

Protecting Patient Health Now and in the Future

Limited cavity access is not just a post-procedural concern. It can severely impede the ability to diagnose and treat all future gynecological issues. A major example is endometrial cancer, as the risk increases dramatically with age.⁶ The disease is most commonly and accurately diagnosed with an endometrial biopsy, but reduced cavity access can make the procedure almost impossible to perform.⁷ This can decrease diagnostic accuracy, which prolongs time to treatment and worsens the prognosis.

Preserving cavity access may be a challenge for some heat-based endometrial ablation methods, but cryotechnology can successfully relieve the symptoms of heavy periods and may keep the uterine cavity open for future medical needs. By freezing cells, cryoablation prompts a different healing response that results in fewer adhesions and scar tissue formations.⁸ As it relates to endometrial ablation, this healing response can result in better cavity access. 

 The Cerene® Cryotherapy Device improves patient health and quality of life in both the short- and long-term. A recent study investigating Cerene’s ability to preserve cavity access reported that, after 12 months, 99% of patients had accessible cavities, and 96% of these cavities had the ability to be evaluated for pathologic change.⁹ In addition to receiving significant relief from heavy bleeding and severe cramping, these patients may still be diagnosed and treated for gynecological issues down the road.

If you’re considering an endometrial ablation for your heavy periods, talk to your doctor about how Cerene can help relieve your symptoms and promote long-term health.

Learn more at https://www.cerene.com/patients/.

Key Takeaways: 

• One of the risks associated with some heat-based endometrial ablation is limited cavity access and visibility, resulting from excessive scar tissue and adhesion formation.
• Lack of uterine cavity access can limit a patient’s diagnostic and treatment options for future gynecological issues.
• Cerene’s cryotherapy technology can minimize the amount of scar tissue the body generates after the ablation procedure, which can preserve uterine cavity access for future medical care.

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. There are risks and considerations associated with the use of the Cerene Cryotherapy Device. Temporary side effects may include uterine cramping, vaginal infection, and lightheadedness. For detailed benefit and risk information, consult the Cerene Instructions for Use (IFU) or your healthcare professional. Learn more >

Sources:

1. 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). 
2. Davis, E. & Sparzak, P.B. (2022, September 9). Abnormal Uterine Bleeding. In StatPearls. StatPearls Publishing. Retrieved February 14, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK532913/ 
3. Wood, M.A., Kerrigan, K.L., Burns, M.K., Glenn, T.L., Ludwin, A., Christianson, M.S., Bhagavath, B., Lindheim, S.R. (2018). Overcoming the Challenging Cervix: Identification and Techniques to Access the Uterine Cavity. Obstetrical & Gynecological Survey 73(11), 641-649.
4. Johns, D.A., Garza-Leal, J.G., Diamond, M.P., Harris, M. (2019). Post-Ablation Cavity Evaluation: A Prospective Multicenter Observational Clinical Study to Evaluate Hysteroscopic Access to the Uterine Cavity 4 Years after Water Vapor Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding. Journal of Minimally Invasive Gynecology 27(6), 1273-1280.
5. Smikle, C., Yarrarapu, S.N.S., Khetarpal, S. (2022, June 27). Asherman Syndrome. In StatPearls. StatPearls Publishing. Retrieved February 20, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK448088/ 
6. Endometrial Cancer Risk Factors. (n.d.). American Cancer Society. Retrieved February 14, 2023, from https://www.cancer.org/cancer/endometrial-cancer/causes-risks-prevention/risk-factors.html 
7. Tests for Endometrial Cancer. (n.d.). American Cancer Society. Retrieved February 14, 2023, from https://www.cancer.org/cancer/endometrial-cancer/detection-diagnosis-staging/how-diagnosed.html 
8. Chen, L.S., Chen, X.Y., Zeng, Y.M. (2015). The different effects of cryoablation and thermal ablation on inflammation and scar hyperplasia in rat skin. Chinese journal of tuberculosis and respiratory diseases 38(6), 451-455.
9. 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.