Abstract
Introduction The studyʼs objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method. Materials and Methods 195 women who were treated with bipolar radiofrequency endometrial ablation between 01/2009 and 06/2016 were included in this prospective cohort study. Postoperative data from 187 women were collected at a median of 17.5 months (IQR 4.5–34.9; 1–82). Multivariate analyses of risk factors were performed. Success was defined as amenorrhoea or spotting. Results Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity 2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median BMI 23.5 kg/m 2 (IQR 21–27). 30 patients (19.5%) had intramural masses that could be measured with ultrasound. Postoperative success rate was 86.1%. 10 patients (5%) had a hysterectomy postoperatively – 6 for heavy bleeding, 3 due to prolapse, and 1 due to dysmenorrhoea. Multivariate analyses showed the presence of intramural masses in women < 45 years was a significant risk factor for therapeutic failure (p = 0.033; 95% CI 1.08–12.57), with an increased risk of hysterectomy (OR 7.9, 95% CI 1.2–52.7, p = 0.033). Conclusion Bipolar radio frequency endometrial ablation was highly successful in the absence of an intramural mass (88%). Even smaller intramural fibroids (DD: adenomyomas of a median of 15 mm) reduce the success rate (76%), which is why preoperative ultrasound is recommended. In the presence of intramural masses, the risk of a hysterectomy for women < 45 years increases eightfold.
Highlights
The studys objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method
Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity 2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median body mass index (BMI) 23.5 kg/m2 (IQR 21–27). 30 patients (19.5 %) had intramural masses that could be measured with ultrasound
Multivariate analyses showed the presence of intramural masses in women < 45 years was a significant risk factor for therapeutic failure (p = 0.033; 95 % CI 1.08–12.57), with an increased risk of hysterectomy
Summary
The studys objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method. The treatment spectrum for excessively heavy menstrual bleeding includes medical and surgical therapeutic approaches. In the 1980s, the methods of hysteroscopic endometrial ablation using YAG laser, transcervical endometrial resection or “rollerball” electrocoagulation were developed [8, 9]. These require visualisation of the uterine cavity and an experienced surgeon. Eight randomised studies investigated the safety, efficacy and costs of endometrial resection as an alternative method to hysterectomy in the treatment of bleeding disorders [10 – 12]. The Cochrane analysis from 2016 concluded that endometrial resection, endometrial ablation and progestogen IUD placement offer a less invasive and yet effective treatment option, in comparison to hysterectomy [13]
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