Long-Term Changes after Thermal Endometrial Ablation Taskin et al Hysteroscopic procedures are performed exten- sively to treat abnormal uterine bleeding to reduce the frequency of major gynecologic surgery. Hysteroscopy- guided inspection and intrauterine surgery produce good results in reproduction-sparing procedures such as myomectomy and polypectomy, and in postrepro- ductive ablative procedures. 1 Abnormal uterine bleeding (AUB) is a common disorder that is frequently treated by hysterectomy. Hysteroscopic endometrial ablation has emerged as an alternative to hysterectomy for women with AUB for whom hysterectomy is relatively contraindicated by medical comorbidity or simply less acceptable. This minimally invasive surgical technique removes or destroys endometrium by electric, laser, or thermal energy. It may be done on an outpatient basis with regional anesthesia or intravenous sedation. However, clinicians and patients alike have been frustrated in predicting the likely risk of postablation bleeding. Not all bleeding symptoms are resolved to the satisfaction of physician or patient. 2–5 Materials and Methods Thirty-four nonmenopausal women (age range 39–54 yrs) underwent hysteroscopic endometrial abla- tion by experienced hysteroscopists. Excluded from the study were women with intrauterine pathology diagnosed at hysteroscopy, including polyps, myo- mata, or adenomyosis. Women with AUB in the absence of physical abnormality at initial ablation, and with at least 30 months of postablation follow-up, 186 From the Departments of Obstetrics and Gynecology (Drs. Taskin, Onoglu, Inal, Turan, and Sadik) and Pathology (Drs. Vardar and Postaci), Inonu University Medical School, Malatya, Izmir, Turkey; and Texas Women’s Hospital, Houston, Texas (Drs. Taskin and Wheeler). Address reprints requests to Omur Taskin, M.D., Department of Obstetrics and Gynecology, Akdeniz University Medical School, Antalya, Turkey; fax 90 242 227 6997. Accepted for publication December 19, 2001. Abstract Study O bjective. To outline long-term histologic features of endometrial ablation. D esign. Prospective longitudinal study (Canadian Task Force classification II-3). Setting. Tertiary-care teaching hospital. Patients. Twenty-six patients. Intervention. Thermal ablation followed by second-look office hysteroscopy with endometrial biopsy. Measurements and Main Results. Mean follow-up time to second-look hysteroscopy after ablation was 33.4 ± 2,1 months. Complete atrophy, partial adhesions or obliteration of the cavity, and fibrosis were observed at sec- ond-look hysteroscopy. Whereas all random biopsies were normal before ablation, biopsies after ablation revealed diminished endometrial glands with necrosis and scarring. The number of endometrial glands was not correlated with amount of bleeding or menstrual pattern. No premalignant or malignant lesions were found after ablation. Conclusion. Although efficacy of endometrial ablation is related to initial thermal destruction and correlated with postablation hysteroscopic and histologic findings, endometrial regrowth is an expected development, not a fail- ure of ablation. (J Am Assoc Gynecol Laparosc 9(2):186–190, 2002) Long-Term H istopathologic and M orphologic Changes after Thermal Endometrial Ablation Omur Taskin, M.D., Ahmet Onoglu, M.D., Murat Inal, M.D., Ersadik Turan, M.D., Salih Sadik, M.D., Enver Vardar, M.D., Hakan Postaci, M.D., and James M. Wheeler, M.D.