Endometrial ablation has emerged as a highly effective solution to manage heavy menstrual bleeding (HMB), offering relief to countless women seeking a more conservative surgical treatment for excessive blood loss and dysmenorrhea. However, a subset of patients experience failed ablation treatments, necessitating further intervention, including a hysterectomy.
One retrospective cohort study analyzing a population of pre-menopausal women who underwent endometrial ablation with heat-based balloon therapy for abnormal bleeding patterns found that certain women experienced diminishing treatment satisfaction and efficacy.1 At a minimum of two years post-treatment, the researchers reported the following results:1
While each patient may define menorrhagia symptoms differently, the primary conclusion that can be drawn from these results is that endometrial ablation is not ubiquitously effective for every patient. Late-onset ablation failure is the most common complication of endometrial ablation, presenting as persistent or recurrent bleeding, cyclic pelvic pain (CPP), and the inability to sufficiently access and visualize the cavity for future diagnostic evaluation.2
Several medical and demographic factors contribute to ablation failure. The top medical causes of suboptimal treatment outcomes, specifically those associated with recurrent bleeding, include:2
In addition to heavy bleeding, patients may also suffer from persistent dysmenorrhea or pelvic pain post- treatment. This is often seen with many heat-based ablation techniques, which rely on endometrial scarring and contracture to reduce or eliminate blood loss and cramping.2 While the formation of intrauterine synechiae is a normal part of the healing process from thermal endometrial destruction, these adhesions are known to interact poorly with functional endometrial glands, resulting in obstructed uterine blood flow and CPP.2
Likewise, the definition of ablation failure is not limited to measurable outcomes. For some patients, the treatment simply does not provide enough improvement in quality of life (meaning they cannot fully perform daily tasks and regularly engage in social activities), in which case patients may ask their gynecologists for a secondary or more invasive procedure. However, many cases of failed ablation could be avoided and/or mitigated with proactive, evidence-based selection criteria.
The key to unlocking higher ablation success rates is improving patient selection. This evaluation extends beyond a patient’s treatment preferences and future plans for childbearing. OBGYNs should also consider how a patient’s treatment outcomes may change with certain conditions. The risk of failed ablation can increase if patients:2
However, selecting the right candidate is just the first step to driving successful treatment outcomes. Even with patients who have met the necessary criteria, there is still a risk of failed ablation. One reason could be the long-term effects of the ablation treatment itself, especially with thermal techniques.
Endometrial cryoablation utilizes freezing technology to foster a different treatment response than heat-based modalities. Cryotherapy activates healing mechanisms that result in minimal scarring and adhesion formation, helping patients experience long-term relief from excessive bleeding and cramping while helping address concerns about scarring complications.3 Despite the lower risk of heat-based damage, it should be noted that cryotherapy also carries a certain level of risk of treatment injury or need for a secondary procedure due to the nature of the ablation treatment.
The Cerene Cryotherapy Device® is an FDA-approved device for safe, well-tolerated, and effective endometrial cryoablation. Cerene deploys nitrous oxide in an ultra-thin, cavity-conforming liner to gently freeze and ablate endometrial tissue, promoting high patient satisfaction while reducing the need for future hysterectomy. Cerene’s innovative cryotherapy technology achieves favorable outcomes for women suffering from HMB, including:
Interested in exploring more clinical benefits of Cerene cryotherapy? 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