Endometrial ablation is appropriate for AUB (heavy menstrual bleeding) in a woman who has completed her family. Which condition is an ABSOLUTE CONTRAINDICATION to endometrial ablation?

• A Uterus size >10 cm
• B Desire for future fertility and/or unexcluded endometrial carcinoma or hyperplasia ✓
• C Adenomyosis
• D Fibroids <3 cm

Explanation

Absolute contraindications to endometrial ablation include: desire for future fertility (ablation renders pregnancy high-risk — placenta accreta, ectopic, miscarriage), endometrial carcinoma or hyperplasia with atypia (must be excluded before ablation to avoid masking or inadequate treatment), active genital infection, and prior endometrial ablation (second-generation devices). Adenomyosis and intracavitary fibroids are relative contraindications reducing success rates but are not absolute contraindications.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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