Background
Endometrial ablation (EA) is an alternative to hysterectomy for abnormal uterine bleeding (AUB), with reduced recovery time and fewer operative risks. However, post‐ablation pain may be associated with subsequent surgery, including hysterectomy. It is uncertain what factors affect surgery rates for post‐ablation pain, particularly with respect to timing and technique of tubal interruption.

Aim
To evaluate the relationship between tubal interruption and post‐ablation pain and subsequent surgery.

Materials and Methods
We conducted a retrospective cohort study involving 324 patients at a Melbourne tertiary hospital from 2009 to 2020. The primary outcome was subsequent pelvic surgery for pain following EA.

Results
Pain following EA was reported by 29.7% of patients, with 10.5% of patients undergoing subsequent surgery for pain. Patients with tubal interruption were more likely to undergo subsequent surgery for pain than those with no tubal interruption (odds ratio (OR): 3.49, 95% CI: 1.59–7.66; P = 0.002). Tubal ligation was strongly associated with subsequent surgery for pain (OR: 3.12, 95% CI: 1.48–6.57; P = 0.003). In contrast, those with salpingectomy did not have an increased risk of subsequent surgery for pain, compared to those with no tubal interruption (OR: 1.5; 95% CI 0.32–7.13). Pre‐ablation pain (adjusted OR: 2.98, 95% CI: 1.37–6.48; P = 0.006) and previous caesarean section (OR: 2.66; 95% CI: 1.13–6.25; P = 0.025) were also associated with subsequent surgery for pain.

Conclusion
Our results suggest that tubal interruption, pre‐ablation pain and previous caesarean section are associated with subsequent surgery for pain. These results can better inform preoperative counselling regarding the risk of subsequent surgery after EA.