The acceptance of MEA in Japan is well demand due to its outstanding effectiveness and safety. Infrequently, a repeat MEA or hysterectomy is needed for recurrent menorrhagia in case of failure ablation. The reasons of recurrent menorrhagia subsequent MEA treatment are unclear. The objective of current study is to identify the possible causes of menorrhagia repetition following MEA, together with the observation of histological changes in the endometrium due to this treatment compared with normal cycling endometrial tissue. A total of 170 patients, 8 (4.7%) of them carried out hysterectomy after 16.8 months (range, 2–29 months) of MEA treatment. Normal (n = 47) and MEA (n = 8) treated paraffin embedded endometrial tissue were prepared for hematoxylin and eosin (H&E) and immunostaining study to recognize the histological changes in the endometrium as a result of MEA treatment. The histological features observed increased tubal metaplasia (TM) including negative expression of the estrogen receptor (ER) and progesterone receptor (PR) in the endometrium subsequent MEA treatment. Increased TM together with the absence of ER and PR expression might be a reasonable explanation for repetition menorrhagia in cases of failure ablation. Further study is required to clarify the molecular mechanisms of tubal metaplasia and the expression loss of hormone receptor in the endometrium as a result of MEA treatment. Current studies propose that low dose estrogen-progestin may not be effective with recurrent menorrhagia patient’s due to the inadequacy of hormone receptor expression in the endometrium following MEA.

MEA因其出色的有效性和安全性而在日本受到广泛欢迎。偶尔，在消融失败的情况下，复发性月经过多需要重复 MEA 或子宫切除术。 MEA 治疗后复发性月经过多的原因尚不清楚。目前研究的目的是确定 MEA 后月经过多重复的可能原因，并观察与正常循环子宫内膜组织相比，这种治疗引起的子宫内膜的组织学变化。共有170名患者，其中8名（4.7%）在MEA治疗16.8个月（范围2-29个月）后进行了子宫切除术。准备正常 (n = 47) 和 MEA (n = 8) 处理的石蜡包埋子宫内膜组织用于苏木精和伊红 (H&E) 和免疫染色研究，以识别 MEA 处理导致的子宫内膜组织学变化。组织学特征观察到输卵管化生 (TM) 增加，包括 MEA 治疗后子宫内膜中雌激素受体 (ER) 和孕激素受体 (PR) 的阴性表达。 TM 增加以及 ER 和 PR 表达缺失可能是消融失败时重复月经过多的合理解释。需要进一步的研究来阐明 MEA 治疗导致输卵管化生和子宫内膜激素受体表达丧失的分子机制。目前的研究表明，由于 MEA 后子宫内膜中激素受体表达不足，低剂量雌孕激素可能对复发性月经过多患者无效。