Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation

OBJECTIVE: Our purpose was to determine whether the depth of endometrial penetration into the myometrium correlates with outcome of rollerball endometrial ablation. STUDY DESIGN: Fifty consecutive patients with hysteroscopically normal-appearing cavities (without gross polyps or submucous fibroids) had endometrial ablations for menorrhagia and were subsequently studied for greater than or equal to 3.5 years. A posterior myometrial biopsy to determine the amount of endometrial penetration was performed and correlated with outcome. RESULTS: Patients with deep endometrial penetration into the myometrium (deep adenomyosis) had poor outcomes after ablation. Those with no or minimal endometrial penetration (superficial adenomyosis) had good results with few exceptions. CONCLUSION: A myometrial biopsy specimen at the time of operative hysteroscopy can diagnose adenomyosis and help predict outcome after rollerball endometrial ablation. Superficial adenomyosis can be treated definitively with ablation. Deep adenomyosis responds poorly to ablation. Hysterectomy should be considered when myometrial biopsy, preoperative ultrasonography, or magnetic resonance imaging demonstrates deep adenomyosis.