Endometrial Cancer After Endometrial Ablation: A Narrative Review

Post-endometrial ablation persistent uterine bleeding indicates that no method of endometrial ablation (EA) eliminates the entire endometrium and hysteroscopy shows distorted and scarred uterine cavity in the majority of women. These observations raise concerns regarding presentation, assessment and stage of potential post-ablation endometrial cancer (PAEC) developing in residual endometrium. To address these concerns, we conducted a systematic search for reports of endometrial cancer (EC) associated with or after EA using multiple data bases imputing keywords of EC after EA and possible combinations of first- and second-generation EA techniques associated with EC from its inception in the 1980s through 2025. After excluding irrelevant publications, we identified 86 ECs associated with EA described in 20 case reports (N=20), four case series (N=18), eleven cohort studies (N=21), one registry (N=27) and five reviews. Based on 12 relevant studies, at follow up of 1.9-25 years, 43 ECs were identified in 39,795 women with a history of EA; summary incidence of 0.11% (range 0.0 - 1.59%). Based on the remaining 43 evaluable cases of PAEC, the mode and time to presentation, investigation, diagnosis, and stage of PAEC were not altered by EA. We conclude that EA has a protective effect reducing the risk EC significantly, likely due to quantitative reduction in endometrium that can potentially become malignant and the EA process eliminating occult pre- or malignant endometrial tissues which are vulnerable to ablation techniques. The mode and time to presentation, the diagnostic work-up, including endometrial biopsy and hysteroscopy, and stage of PAEC are not altered by EA.