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65: Contraceptive choices after endometrial ablation from 2007-2012 at an academic medical center

      Objectives

      All premenopausal women who undergo endometrial ablation should be counseled to use reliable contraception due to significant reported complications in ensuing pregnancies. Nevertheless, there have been several reported post-ablation pregnancies in women up to age 50. This is the first study to characterize contraceptive choices women make after endometrial ablation.

      Materials and Methods

      A retrospective chart review was performed on all women undergoing ablation at an academic tertiary care center from January 2007 to May 2012. Continuous features were summarized with medians and interquartile ranges (IQR), and categorical features were summarized with percentages. Comparisons of contraceptive choices between age groups were evaluated using the chi-square test. P-values .05 and below were considered statistically significant.

      Results

      Endometrial ablation was performed in 496 premenopausal women (median age 44.5; IQR 41-49). Prior to ablation, women relied on permanent sterilization (75%), long acting reversible contraceptives (LARCS; 2.6%), reversible hormonal contraceptives (5.2%), barrier methods and fertility awareness (5.9%), and withdrawal (.2%); 8.1% of sexually active women did not use any contraception. Of the 124 patients who did not already rely on permanent sterilization, 46 (37%) underwent a concurrent contraceptive procedure at the time of ablation. Of these, nine elected concomitant laparoscopic sterilization, 31 chose hysteroscopic sterilization, and 6 had an intrauterine device placed. Following ablation, women utilized permanent sterilization (82.3%), LARCs (1.4%), reversible hormonal contraceptives (1%), barrier methods and fertility awareness (1.4%), and withdrawal (.2%); however, 9.7% of sexually active women did not use any contraception. There were no reported pregnancies. Pre- and post-ablation contraceptive choices were stratified by age less than 45 years (n=226) and age 45 and above (n=270). Prior to ablation, women less than 45 relied on permanent sterilization more often (79.2% vs. 71.5%; p=.05). This younger cohort more commonly underwent concurrent procedures for contraception at the time of ablation (p=.009). Following endometrial ablation, women 45 and above were significantly more likely to forego contraception use altogether (13.3% vs. 5.3%; p=.003) and to use barrier methods or fertility awareness (2.6% vs. 0%; p=.02).

      Conclusion

      Although many women elect reliable contraception after endometrial ablation, there is a considerable subgroup that chooses less reliable options. This pattern is pronounced in premenopausal women ages 45 and above, though they may still be at risk for pregnancy. Women of all age groups may benefit from tailored pre-ablation contraceptive counseling to decrease the post-ablation pregnancy rate.