The importance of contraception counselling in women who are in
reproductive age and undergoing endometrial ablation techniques – a case report
H Moukarram, J.M Jilumudi, K.V Chia
Royal Bolton Hospital, Obstetrics and Gynaecology, Bolton/Lancashire,
UK
A 41-year old woman presented to
the antenatal clinic in her first pregnancy. An ultrasound scan confirmed an
eleven weeks intrauterine pregnancy. At 19 weeks gestation she didn’t want to
continue with the pregnancy and requested termination of pregnancy, which was
done medically. Six months prior to her presentation she underwent microwave
endometrial ablation (MEA) for polymenorrhagia which was unsuccessfully treated
medically. She became amenorrhoeic two months following the MEA and it was
thought to be the result of her therapy. Contraception advice was not offered
after her MEA. Previously she was treated for primary infertility. This
treatment stopped after unsuccessful attempts in assisted conception.
Discussion
Microwave endometrial ablation (MEA) is one of the second generation endometrial
ablation techniques used to treat women with menorrhagia. The microwave energy
is delivered into the uterine cavity by an applicator, where it is radiated in a
hemispherical pattern from the tip of the applicator. During the procedure the
temperature inside the uterine cavity is monitored and maintained between 70°C
and 80°C. The ablation aims to stop menses by making the endometrium thin and
necrotic. However, if the ablation is incomplete, the resumption of menses is
not unusual and the possibility of pregnancy is raised. It has generally been
assumed that conception after an ablation is very unlikely. The overall
pregnancy rate after an ablation appears to be 0.65 % (Roy and Mattox 2002).
Reports of pregnancy after endometrial ablation are quite limited; Hare reviewed
the literature and found that, to date, only 70 pregnancies have been reported
(Hare and Olah 2005). Even patients with a history of infertility have conceived
after endometrial ablation (Goldberg 1994).
Conclusion Although endometrial
ablation should only be offered to women who are not interested in future
pregnancies, all patients should be counselled on contraception even if they had
a history of infertility.