Design: Observational study

Setting: Office based hysteroscopy in a large multi-city integrated health system involving 19 clinical locations

Patients or Participants: All patients undergoing outpatient office based endometrial ablation using the MARA device between 10/1/2022-1/31/2024 (16 months).

Interventions: Endometrial ablation using MARA device with oral medication (which included a combination of NSAIDs, benzodiazepines, and opiates), intramuscular ketorolac and a paracervical block.

Measurements and Main Results: 197 endometrial ablations using the MARA device were performed in the office setting over a 16-month period. Immediately after the completion of the ablation, patients were asked to report their pain during the procedure using the Visual Analog Score (0 to 10). Of the 128 (65%) with documented pain scores, 59% (n=75) rated their pain 5 or lower. The most common reported score was 4/10, and 8% (n=10) reported feeling no pain whatsoever. Patients were also asked to compare pain experienced during the ablation to pain experienced during their typical menses. Of the 117 (59%) patients with this information documented, 37% (n=43) of patients reported their pain was less than pain experienced during their menses, whereas 28% (n=33) reported it to be equally as painful and 35% (n=41) reported it to be more painful than their menses.

Conclusion: Endometrial ablation with the MARA device is well tolerated in the majority of patients, with 65% of patients reporting the procedural pain to be similar to or less than menstrual pain. This procedure was associated with similar Visual Analog Scores seen in research assessing hysteroscopy. This data will help clinicians make informed decisions when selecting an endometrial ablation device and will assist in counseling patients on expectations when preparing for the procedure. This is the largest study published to date on the MARA device and the only study examining intra-procedure pain.