Endometrial resection versus vaginal hysterectomy for the surgical treatment of menorrhagia

Abstract

To evaluate the efficacy of treatment with endometrial resection versus vaginal hysterectomy in patients with established menorrhagia, 85 women under age 50 years were recruited in an open-label, randomized, clinical trial. Eligible subjects had a mobile uterus with a volume less than a 12-week pregnancy, and no adnexal tumors or submucous myomas with a diameter greater than 3 cm. The patients were asked to grade the degree of satisfaction with their treatment and any modifications in sexual activity 1 year after surgery. Median (interquartile range, IR) operating time was, respectively, 13 minutes (10-15 min) in the endometrial resection group (group 1,41 women) and 71 minutes (66-78 min) in the hysterectomy group (group 2, 44 women). No important complications occurred. Median number of days to return to normal activities and to work were, respectively, 8 (IR 6-8) and 14 (]R 11-16) days in group 1 versus 13 (IR 13-15) and 30 (IR 26-34) in group 2. Four women in group 1 subsequently underwent vaginal hysterectomy, two for recurrent menorrhagia, one for dysmenorrhea, one for atypical hyperplasia. Among the 82 women attending the 1-year follow-up visit, 34 (87%) of those in group 1 were very satisfied or satisfied with their treatment compared with 41 (95%) of those in group 2 (NS). Sexual activity was unchanged in 32 (84%) subjects in the former versus 33 (85%) women in the latter group. Endometrial resection and vaginal hysterectomy seem to be equally effective at 1 year after surgery for menorrhagia.