Ultrasonographic and hysteroscopic follow up after transcervical resection of the endometrium

Abstract

Objective Long-term follow-up of women who have undergone transcervical resection of the endometrium (TCRE), and evaluation of the uterine endometrium and cavity in these women. Design Transvaginal ultrasound examination (TVS) with hydrosonography and hysteroscopy, including biopsies, was carried out in 61 women, 19–67 months (mean 40 months) after transcervical endometrial resection. Results The age range of the women was 37–58 years (mean 48 years). Of 61 women, 67% had amenorrhoea or hypomenorrhoea, 28% had withdrawal bleeding of normal amounts and three women suffered from polymenorrhoea. Of 40 women with dysmenorrhoea before treatment, 18 still had cyclic pain afterwards. In three women, dysmenorrhoea developed postoperatively. At ultrasound examination, an echo from the uterine cavity was found in 95% of the women and an echo of 5 mm or more was seen in 22%. Crypts and occlusions were present in 19% and synechiae in 4% of the women. For technical reasons, hydrosonography could not easily be done. At hysteroscopy signs of endometrium were found in 85% of the women, and synechiae were present in all women. The uterine cavity was partly occluded and narrowed. One woman had a total occlusion of the uterine cavity. Histopathological examination of the biopsies or curettage specimens from the uterine cavity showed endometrial tissue in 67% of the women. Conclusions Residual endometrium was found in most women after TCRE and, therefore, if hormone replacement therapy is to be used, a combination of oestrogen with gestogen should be recommended. Intracavitary synechiae were present in most women after TCRE. The synechiae may have contributed to the cyclic pain experienced by 20 women after treatment. However, the synechiae did not seem to conceal the withdrawal bleeding or menstruation. If women who have undergone TCRE develop symptoms such as bleeding and/or pain, both vaginal ultrasound and hysteroscopy with directed biopsies should be recommended.