Endometrial Cancer Related to Endometrial Ablation: A Narrative Review

Persistent post-endometrial ablation uterine bleeding indicates that no method of EA eliminates the entire endometrium, and post-EA hysteroscopy shows a distorted and scarred uterine cavity in the majority of patients. These observations raise concerns regarding presentation, assessment and stage of potential post-ablation endometrial cancer (PAEC), developing in residual endometrium pockets. To better understand these concerns, a literature search was conducted, from the introduction of EA in the 1980s through 2025, to capture reports of endometrial cancer (EC) associated with or following EA using multiple data bases, imputing search terms of EC following EA and possible combinations of first- and second-generation EA techniques associated with EC. Upon review of all publications, we identified 86 ECs associated with EA, described in 20 case reports (N = 20), four case series (N = 18), eleven cohort studies (N = 21), one registry (N = 27) and five reviews. Based on 12 relevant studies at a median follow-up of 8.5 years (range 1.9-25), 43 EC were identified in 39,795 women with a history of EA, with a summary incidence of 0.11% (range 0.0-1.59%). Although the studies and data are very heterogeneous, it appears that EA may afford a protective effect in reducing the risk of EC in the short term. The mechanistic effect is likely due to a quantitative reduction in the endometrium that can potentially become malignant, and/or due to the elimination of occult pre- or malignant endometrial elements which are vulnerable to EA. Moreover, based on 25 evaluable cases, the mode and time to presentation, the diagnostic work-up (including endometrial biopsy and hysteroscopy), and the stage of PAEC appear not to be altered by EA.