Abstract
Dear Editor:
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As you stated in your letter, our study was a retrospective review of patients treated by global endometrial ablation (GEA) and their resulting symptomatology in the ensuing 2 years. We recognize the cohort size limitation of our review and address that limitation in our article. We agree that a powered study would add more insight into this phenomenon, and we are in the process of formulating a prospective, randomized powered study to do so.
The intent of our study was to investigate if, in fact, some postprocedural differences in “healing” would be evident based on modality of therapy. We were inspired to follow that theory based on the presented work of Coad. 1 In this pathological correlate to treated uteri, Coad explains that “higher energy devices appear to be associated with a partial ‘etiologic switch’ from dysfunctional endometrium to treatment-related vascular changes as the cause of continued bleeding (and pain).” This was the impetus/background for our investigation. We are aware that more detailed work and data are needed until this topic is fully elucidated.
As a response to the use of our VAS scale for pain level documentation, yes, some patients were asked to rate their pain/discomfort level over a telephone call. However, all patients for whom that was performed had a detailed explanation of the scale premise. We are unaware of any published report documenting variability in pain reporting using the visible scale versus scale description.
We are aware of the Brandsborg et al. article. 2 However, as the focus of their report of hysterectomized patients/extirpative therapy, we would caution its applicability to a uterine conservational therapy such as GEA.
Finally, as a continuation of our study, we are in the process of evaluating the pathological changes, if any, found between the two cohorts for those patients who proceeded to hysterectomy.
We are proud to have contributed new, never before considered information on the topic of de novo pain after GEA. While our study does have limitations, as any study possesses, the ability of any GEA device to result in de novo pain symptoms is evident. We simply sought to address this issue, as most reports on GEA concentrate on menorrhagia reduction and not on the basic premise of “first do no harm.”
We encourage and invite Dr. Evantash and others to pursue (as we currently are) prospective, randomized trials to delineate this issue for better patient care.