Re-audit: transcervical resection of the endometrium for heavy menstrual bleeding and the treatment of post-resection uterine stenosis and haematometra by cervical dilatation and the insertion of a levonorgestrel-releasing intra-uterine system

Abstract

The audit objectives: To assess the outcome of the treatment of: (1) heavy menstrual bleeding by transcervical resection of the endometrium, (2) post-resection uterine stenosis and haematometra by cervical dilatation and levonorgestrel-releasing intra uterine system. The audit design: A retrospective re-audit. The setting: A district general hospital in the North West region of England, U.K. The patients: Forty-seven women with heavy menstrual bleeding that required treatment with transcervical resection of the endometrium. The interventions: Transcervical resection of the endometrium, cervical dilatation and the insertion of levonorgestrel-releasing intra uterine system. The main outcome measures: Clinical improvement and the need for further surgery, including hysterectomy. The results: Transcervical resection of the endometrium improved the symptoms of 80.9% of the women. The problem of six out of seven women with post-resection uterine stenosis and haematometra was resolved by cervical dilatation and the insertion of levonorgestrel-releasing intra-uterine system. The conclusion: Transcervical resection of the endometrium for heavy menstrual loss is a safe and effective procedure. Cervical dilatation and the insertion of levonorgestrel-releasing intra-uterine system saved some women with post-resection uterine stenosis and haematometra from having further surgery. The two interventions combined saved 93.6% of the women from having hysterectomies.