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Outcomes After Rollerball Endometrial Ablation for Menorrhagia

From the Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara; and Division of Research, Kaiser Permanente Medical Care Program, Oakland, California.

Address reprint requests to: Caryn Dutton, MD, Department of Obstetrics and Gynecology, Women’s and Children’s Hospital, LAC-USC Medical Center, 1240 North Mission Road, Room L1009, Los Angeles, CA 90033.

OBJECTIVE: To evaluate the outcomes of women undergoing rollerball endometrial ablation for menorrhagia and to identify factors associated with those outcomes.

METHODS: Data on the clinical history, operative technique, and follow-up status as of August 1998 were obtained by retrospective medical record review for 240 women undergoing rollerball endometrial ablation with or without resection of polyps or myomas from January 1991 through December 1996. The incidence of subsequent hysterectomy was calculated by survival analysis, and Cox proportional hazard models were used to identify the predictors of success or failure of the procedure.

RESULTS: The mean follow-up time was 31.2 months. Twenty-nine women (31% of the available subjects) who had not undergone hysterectomy were still being monitored 5 years after the rollerball endometrial ablation. Overall, the probability of no hysterectomy in the first 5 years was 71%. Ablation was repeated in 10 patients, six of whom eventually underwent hysterectomy. Multivariate analysis identified previous tubal ligation as a statistically significant positive predictor of the risk of hysterectomy (hazard ratio 2.20, 95% confidence interval [CI] 1.18, 4.09). Women at least 45 years old had a lower risk of subsequent hysterectomy than those younger than 35 years of age (hazard ratio 0.28, 95% CI = 0.10, 0.75).

CONCLUSION: The results of this study confirm the effectiveness of rollerball endometrial ablation for the treatment of menorrhagia for a longer duration of follow-up than in most previous reports. Repeated ablation and a younger age at the time of ablation increase the risk of requiring a subsequent hysterectomy.

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