Life-table analysis of the success of thermal balloon endometrial ablation in the treatment of menorrhagia

Abstract

Objective To evaluate the change in intrauterine pressure during thermal balloon endometrial ablation and to identify risk factors associated with treatment failure. Design Prospective observational study. Setting University-affiliated teaching hospital. Patient(s) Seventy two consecutive patients with idiopathic menorrhagia refractory to medical treatment. Intervention(s) Thermal balloon endometrial ablation under patient-controlled sedation. Main outcome measure(s) Change in intrauterine pressure during the treatment cycle and risk factors associated with treatment failure. Result(s) A spontaneous decrease in intrauterine pressure occurred in most patients (93%). The mean (±SD) decrease was 34.1 ± 14.9 mm Hg, or 19.5% ± 9.1%. The treatment failed in 10 patients (13.9%), and the mean end pressure was significantly lower in this group (131.1 ± 14.1 mm Hg vs. 145.1 ± 18.0 mm Hg; P=.02). The chance of success of treatment was significantly lower when the end pressure was <140 mm Hg (odds ratio, 0.42 [95% CI, 0.27 to 0.68]; P=.01), the intrauterine volume was >10 mL (odds ratio, 0.43 [95% CI, 0.22 to 0.83]; P=.058) and the uterus was retroverted (odds ratio, 0.36 [95% CI, 0.20 to 0.65]; P=.008). Conclusion(s) Maintaining high intrauterine pressure during the treatment cycle and correction of the retroversion may help to improve treatment success in thermal balloon endometrial ablation.