Endometrial Ablation With or Without Intrauterine Device Insertion for Abnormal Uterine Bleeding: A Comparison of...

This study aims to evaluate the outcomes of endometrial ablation alone versus endometrial ablation with levonorgestrel intrauterine device (LNG-IUD) insertion. Secondary aims include the feasibility of re-instrumentation of the uterus after endometrial ablation with and without IUD placement.

Retrospective age matched cohort.

The setting was at three academic, tertiary care centers.

There were 485 patients aged ≥ 18 years who had undergone endometrial ablation with and without LNG-IUD insertion between 1999 and 2023.

All patients underwent an endometrial ablation. A total of 244 patients underwent endometrial ablation alone, and 241 patients received ablation with concomitant IUD placement.

There were no significant differences in age at ablation, prior surgical history, or pre-operative diagnosis of dysmenorrhea or pelvic pain between groups. Patients were noted to have a higher body mass index (>30) in the ablation with the LNG-IUD group (p = .002). The ablation alone group (20.1%, 49/244) was more likely to undergo a subsequent hysterectomy compared to the ablation with LNG-IUD group (9.5%, 23/241 (p = .001) at any point in time, but the 4 year cumulative incidence of hysterectomy was 11.6% (95% confidence interval [CI]: 7.5-18.0) in the IUD group and 7.2% (95% CI: 4.6-11.4) in the ablation alone group. Post-operatively, the ablation with LNG-IUD group was noted to have higher rates of new-onset pelvic pain (6.4% vs 0.4%; p <.001). The ablation-alone group was to have an endometrial biopsy after ablation (p <.001). 3% (n = 7) of patients in the LNG-IUD group had the IUD replaced during the follow-up period. After adjusting for potential confounders, time to hysterectomy did not significantly differ by group (p = .946).

Time to hysterectomy was not significantly different in patients with concomitant LNG-IUD placement at time of endometrial ablation compared to ablation alone. In addition, this study shows that re-instrumentation of the uterus after an ablation with and without an IUD may be feasible.