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Patients with heavy menstrual bleeding who do not wish to preserve their fertility are offered endometrial ablation. In the absence of structural abnormalities, patients have access to non-resectoscopic endometrial ablation techniques.
Endometrial ablation is an effective treatment option for patients with heavy menstrual bleeding and a normal uterine cavity. Patients who choose to have endometrial ablation require endometrial sampling to rule out cancer before the procedure; testing for cancer becomes difficult once the endometrial lining is destroyed. Patients who chose endometrial ablation require contraception for the rest of their childbearing years.
Non-resectoscopic endometrial ablation techniques—also known as second-generation techniques—use a variety of energy sources to non-selectively destroy the endometrial lining. These techniques are preferred as they require shorter surgical time and less specialized training and are easier to perform. They can be performed in an outpatient setting with local or conscious sedation, and result in fewer complications related to fluid overload and uterine perforation. All patients considering endometrial ablation should have access to non-resectoscopic endometrial ablation techniques.
If you never want to get pregnant, your gynecologist may offer an endometrial ablation, which removes the lining of the uterus. This procedure makes pregnancy unsafe for you, so you will need to use contraception for the rest of your childbearing years.
Offer endometrial ablation as one of the first-line treatment options for heavy menstrual bleeding. If your patient chooses this option, first perform endometrial sampling. Non-resectoscopic techniques done without general anesthetic are the methods of choice for endometrial ablation.
Ensure systems, processes, and resources are in place such that all patients have access to non-resectoscopic endometrial ablation techniques. Ensure clinicians are aware of gynecologists who accept referrals for endometrial ablation.
Percentage of patients with heavy menstrual bleeding who had endometrial ablation, by type of ablation (any, resectoscopic, non-resectoscopic)
Denominator: number of patients with heavy menstrual bleeding
Numerator: number of patients with heavy menstrual bleeding who had endometrial ablation, by type of ablation:
Any
Resectoscopic
Non-resectoscopic
Data sources: local data collection, Ontario Health Insurance Plan claims database, Discharge Abstract Database
Note: Each type of ablation should be calculated separately as well as the overall rate.
Percentage of patients with heavy menstrual bleeding who had endometrial ablation and who had endometrial sampling within 3 months before the procedure
Denominator: number of patients with heavy menstrual bleeding who had endometrial ablation
Numerator: number of patients in the denominator who had endometrial sampling within 3 months before the procedure, including the day of the procedure
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