Ultrasound Appearance of the Endometrium Post Radio-Frequency Ablation

INTRODUCTION: Heavy and irregular menses affects 9-14% of gynecologic patients, and second-generation endometrial ablation is a treatment option when medications fail. Limited studies have been performed assessing the radiologic appearance of the endometrium post-ablation. Our study aims to describe the ultrasonographic appearance of the post-ablative endometrium to improve knowledge of its sonographic findings. METHODS: This was an institutional review board (IRB)-approved prospective study of patients who underwent second-generation endometrial ablation from 2016 to 2019. Patients had postoperative transvaginal ultrasounds at 2, 6, and 12 months. Ultrasound reports were analyzed for endometrial thickness, description of the endometrium and myometrium, presence of uterine fibroids, and uterine size. Statistical tests for repeated measures were utilized. RESULTS: There were 68 patients with an average age of 42 (standard deviation [SD] 6) and a body mass index of 32.5 (SD 8.1). Preoperatively the average endometrial thickness was 10mm, uterine length was 9.7cm, and 38.2% had leiomyoma. The average endometrial thickness decreased at each ultrasound: 8.4mm (SD 3.4), 7.2mm (SD 3.0), and 5.8mm (SD 2.5) at 2, 6, and 12 months, respectively. When comparing endometrial thickness postoperatively there was a significant difference at 2 and 12 months ( P =.041) and at 6 and 12 months ( P =.031). There was no change during the postoperative period in the presence of leiomyoma, hyperechoic endometrium, hypoechoic endometrium, heterogeneous endometrium, and cystic endometrium on the ultrasounds. CONCLUSION: After ablation with a second-generation device, the endometrial thickness on ultrasound decreases with time following surgery. Additional studies correlating these findings to clinical outcomes would be useful.