Before the Burn: Predicting Endometrial Ablation Failure

Background While endometrial ablation (EA) offers a minimally invasive alternative to a hysterectomy for women suffering from abnormal uterine bleeding (AUB), clinicians currently lack reliable predictive tools to identify which patients will experience treatment failure, leaving both providers and patients to make treatment decisions with incomplete prognostic information. Aims The aim of this study is to identify factors that are associated with failure of EA, and use these to develop and internally validate a model predicting failure after EA. Materials and Methods Participants Women who have undergone an EA at a tertiary health service between the years of 2015 and 2021. Design Retrospective cohort study. Results Of the 646 patients who underwent an EA between 2015 and 2021, 21% required ongoing treatment. A model for predicting the failure of endometrial ablation was developed. The presence of fibroids and increasing BMI was associated with failure of EA. Increasing age and insertion of the Mirena at the time of EA made failure less likely. Conclusions Despite many years of evidence supporting different factors that are associated with failure after an EA, this is the first study to develop a predictive model using Australian data and the first model incorporating the use of Mirena. Ongoing research is suggested to improve model performance and then validate the model externally prior to using it in a clinical context. The nomogram is a demonstration of a possible application of a predictive model.