Abstract
Objectives: To detect the outcome and changes in uterine arteries blood flow after hysteroscopic roller-ball endometrial ablation. Methods: 84 women with menorrhagia refused to continue or had failed medical treatment with uterine size <12 weeks were included in this study. Diagnostic hysteroscopy was done for women included in this study prior to endometrial ablation. A rigid operative hysteroscopy, with normal saline distention media and roller-ball electrode were used for endometrial ablation procedure. Preoperative findings of studied women including Doppler findings were compared to 3, 6 and 12 months post-operative findings to detect outcome and changes in uterine arteries blood flow after hysteroscopic roller-ball endometrial ablation. Results: 77/84 (91.7%) women were satisfied and their HMB was improved after rollerball endometrial ablation (33/84 (39.30%) amenorrhea, 27/84 (32.14%) hypo-menorrhea and 17/84 (20.24%) euomenorrhea = normal menstrual flow). ED (End Diastolic velocity), (9.2±7.4 cm/s before ablation) was significantly decreased 6 and 12 months after roller-ball endometrial ablation (5.0±6.0 and 4.6±6.1; respectively), also, TAMX (Time-averaged maximum velocity), (21.8±8.2 cm/s before ablation) was significantly decreased 6 and 12 months after roller-ball ablation (14.8±6.4 and 13.9±6.3; respectively). PI (Pulsatiliy Index), (1.32±0.5 cm/s before ablation) was significantly increased 6 and 12 months after roller-ball ablation (1.64±0.45 and 1.69±0.4; respectively), also, RI (Resistance Index), (0.80±0.2 cm/s before ablation) was significantly increased 3, 6 and 12 months after roller-ball ablation (0.84±0.4, 0.89±0.2 and 0.90±0.3; respectively). Conclusion: Hysteroscopic roller-ball endometrial ablation is a safe and effective therapeutic option for selected cases of menorrhagia. It increases stiffness and decreases mobility of uterine arteries during cardiac cycle, also, it induces rise in impedance with subsequent decrease in uterine blood flow and menstrual flow which completed 6-12 months following ablation procedure.
Highlights
Dysfunctional uterine bleeding (DUB) is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause to explain the bleeding [1]
Hysteroscopic roller-ball endometrial ablation is a safe and effective therapeutic option for selected cases of menorrhagia. It increases stiffness and decreases mobility of uterine arteries during cardiac cycle, it induces rise in impedance with subsequent decrease in uterine blood flow and menstrual flow which completed 6-12 months following ablation procedure
Eighty four (84) women with menorrhagia (HMB) without inter-menstrual bleeding (Pictorial Blood Loss Assessment Chart) [10,11] refused to continue or had failed medical treatment with uterine size
Summary
Dysfunctional uterine bleeding (DUB) is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause to explain the bleeding [1]. Menorrhagia or heavy menstrual bleeding (HMB) over several consecutive cycles during reproductive years is the most frequent form of DUB. HMB is a significant health problem in premenopausal women, it can cause anemia and reduce quality of life [4]. Menorrhagia is one of the most common causes for referral of pre-menopausal women to gynecologists, and, inspite of medical therapy, many women will eventually require hysterectomy [4,5]. Trans-vaginal Color Doppler ultrasonography enables us to discover the changes which occur in the uterine arteries blood flow after hysteroscopic endometrial ablation. This study was designed to detect the outcome and changes in uterine arteries blood flow after hysteroscopic endometrial ablation
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