Pathologic characteristics of hysterectomy specimens in women undergoing hysterectomy after global endometrial ablation

Study objective: To describe uterine pathologic features in women who underwent hysterectomy because of failed global endometrial ablation (GEA).

Design: Retrospective cohort study from 1998 through 2005 (Canadian Task Force classification III).

Setting: Tertiary referral center.

Patients: Sixty-nine women who underwent hysterectomy because of GEA failure.

Interventions: Pathology reports were available for 67 patients. Descriptions of hysterectomy specimens after GEA were reviewed.

Measurements and main results: Rates of pathologic findings in hysterectomy specimens after failed GEA were determined. Reasons for hysterectomy in the 67 patients with available pathology reports were bleeding in 34 (51%), pain in 19 (28%), and bleeding and pain in 14 (21%). The pathology reports of these specimens showed leiomyomas in 33 specimens (49%); intramural myomas were present in 15 women (44%) who underwent hysterectomy because of bleeding and 8 women (42%) who underwent hysterectomy because of pain. Hematometra was identified in 7 pathologic specimens (10%). Specifically, hematometra was identified in specimens from 5 of 19 women who underwent hysterectomy because of pain (26%).

Conclusion: Hematometra was a significant finding in women who underwent hysterectomy because of persistent pain after GEA. A possible pathologic predictor of GEA failure may be intramural leiomyomas.