Uterine ultrasound findings after radiofrequency endometrial ablation: correlation with symptoms

To determine pelvic ultrasound characteristics in women after radiofrequency endometrial ablation (EA) and evaluate the association of those characteristics with symptoms and the need for subsequent therapeutic intervention.

This retrospective cohort study evaluated patients who underwent transvaginal pelvic ultrasound after radiofrequency EA between July 3, 2006, and November 13, 2009. The presence or absence of postablation symptoms (pelvic pain or vaginal bleeding) at the time of ultrasound defined the 2 groups. Two radiologists evaluated 17 ultrasound parameters. Demographic, clinical, and ultrasound characteristics were compared between symptomatic and asymptomatic patients, and features were assessed for association with subsequent therapeutic interventions.

Of the 91 patients who had radiofrequency EA and subsequent ultrasound, 63 patients (69.2%) were symptomatic on evaluation. Symptomatic patients were significantly more likely than asymptomatic patients to have an endometrial thickness of 3 mm or more, a heterogeneous endometrial echotexture, and leiomyomas (P = 0.004, P = 0.008, and P = 0.05, respectively). The most frequent finding in all patients was an indistinct endometrial border (66/79 [83.5%]). In addition, there was a tendency for patients with leiomyomas to have a subsequent intervention (P = 0.07). Although infrequent, all patients (7/91) with cornual hematometra or proximal hydrosalpinx had pain.

Indistinct endometrial border is a common finding after radiofrequency EA and is unrelated to the presence or absence of symptoms. Patients who present with post-radiofrequency EA symptoms seem to have a few specific ultrasound characteristics that differentiate them from asymptomatic patients. The presence of leiomyomas on ultrasound is predictive of the need for therapeutic interventions.