Endometrial ablation in patients with myomas

This review evaluates how the presence of uterine myomas may limit the ability to provide endometrial ablations for patients with menorrhagia, affect subsequent postoperative course and alter long-term outcome. New instrumentation and the off-label use of some global ablation techniques allow some selected patients with submucosal myomas to be treated solely by endometrial ablation. The addition of an endometrial ablation in patients undergoing a hysteroscopic myomectomy improves bleeding and their long-term control, but does not decrease the subsequent need for a hysterectomy. Necrosis of intramural myomas is a rare postoperative complication. Untreated myomas may continue to increase in size and lead to a hysterectomy. The presence of myomas in patients undergoing endometrial ablation may compromise the results and lead to later problems, but most patients can be treated successfully and myomas are not an absolute contraindication.