Design: We performed a retrospective cohort study of all patients who underwent endometrial ablation from January 1, 2011 to January 1, 2021 at a single academic institution.

Setting: N/A

Patients or Participants: 1072 patients who met inclusion criteria and were included in the analysis.

Interventions: N/A

Measurements and Main Results: Of the 1072 patients who underwent an endometrial ablation, 191 (17.8%) went on to have a hysterectomy. The majority of these hysterectomies were performed for persistent abnormal uterine bleeding and pelvic pain. Forward stepwise logistic regression was used to account for the effect of specific categorical variables on the probability of hysterectomy after ablation. Patients who required a hysterectomy were more likely to have a higher BMI and identify as Black or African-American (p<0.01). Over 16% of final hysterectomy specimens showed evidence of adenomyosis.

Conclusion: Endometrial ablation has become a popular choice for treatment of abnormal uterine bleeding, given its minimally invasive nature and cost-effectiveness. When counseling patients for treatment with endometrial ablation, it is important to inform them of the risk of treatment failure and the need for hysterectomy. Our study aimed to identify risk factors that lead to endometrial ablation failure to improve patient counseling. Previous studies have quoted a 12-13% risk of hysterectomy following endometrial ablation, however our study found a higher rate of hysterectomy – approaching 18%. Our results indicate that women with higher BMI and those who are Black or African-American are more likely to fail an endometrial ablation. In addition, adenomyosis was present in a large proportion of final hysterectomy specimens. These findings can be used to enhance patient counseling and selection of appropriate candidates for endometrial ablation.