Persistent Menorrhagia Research Articles

Endometrial laser intrauterine thermotherapy for the treatment of dysfunctional uterine bleeding: the first British experience.

Forty patients due to undergo endometrial ablation as a treatment for dysfunctional uterine bleeding were recruited to assess the efficacy and safety of endometrial laser intrauterine thermo-therapy using the gynelase. At 12 months the average menstrual score reduction was 88%, the amenorrhoea rate was 70%, and the hypomenorrhoea rate 16%. Four women (10%) have had a hysterectomy for persistent menorrhagia, and one (3%) for pelvic pain. One patient (3%) has had a further endometrial laser ablation. There were no major complications. and 34 patients (85%) were most satisfied with the treatment. The system is easy to use and has a short learning curve.

Endometrial laser intrauterine thermotherapy for the treatment of dysfunctional uterine bleeding: the first British experience

Forty patients due to undergo endometrial ablation as a treatment for dysfunctional uterine bleeding were recruited to assess the efficacy and safety of endometrial laser intrauterine thermo-therapy using the gynelase. At 12 months the average menstrual score reduction was 88%, the amenorrhoea rate was 70%, and the hypomenorrhoea rate 16%. Four women (10%) have had a hysterectomy for persistent menorrhagia, and one (3%) for pelvic pain. One patient (3%) has had a further endometrial laser ablation. There were no major complications, and 34 patients (85%) were most satisfied with the treatment. The system is easy to use and has a short learning curve.

Endometrial Thermal Balloon Ablation with the ThermaChoice System: Effect of Intrauterine Pressure and Duration of Treatment

Study Objective To determine the safety and efficacy of thermal balloon therapy under variable intrauterine pressures and durations of treatment. Design Retrospective cohort study. (Canadian Task Force classification II-1). Setting University-affiliated teaching hospital. Patients Sixty-six women with menorrhagia. Intervention Eighteen patients were treated with the ThermaChoice thermal balloon system for 8 minutes at 80 to 150 mm Hg pressure, 15 were treated for 8 minutes at 151 to 180 mm Hg, and 33 were treated for 12 to 16 minutes at 151 to 180 mm Hg. Measurements and Main Results No intraoperative complications occurred and postoperative morbidity was minimal. At 12 to 24 months follow-up, persistent menorrhagia was reported in 56% of women treated at 80 to 150 mm Hg compared with 20% treated at 151 to 180 mm Hg for 8 minutes (p = 0.01), and in 24% treated for 12 to 16 minutes at 151 to 180 mm Hg (p = 0.1). Conclusion Thermal balloon endometrial ablation is a safe and effective treatment for menorrhagia. Balloon pressure greater than 150 mm Hg increased the effectiveness of treatment. Success was not affected or influenced by increasing the duration of treatment from 8 to 12 minutes or more.

Evaluation of hydro thermablator for endometrial destruction in patients with menorrhagia

To describe endometrial destruction with the Hydro ThermAblator. (Canadian Task Force classification II-1). University-affiliated hospital. Twenty-six women with uncontrolled menorrhagia. Endometrial ablation with saline heated to 90 degrees C and circulated in the uterine cavity for 10 minutes under hysteroscopic control. All patients tolerated the procedure well, all but one was satisfied with the results, and there were no significant side effects or complications. Seventy-seven percent of women were either amenorrheic or hypomenorrheic after 6 months, and 88% were amenorrheic or hypomenorrheic after 1 year, including one patient who was treated a second time; 87.5% were amenorrheic or hypomenorrheic at 18 months. One woman had persistent menorrhagia and was treated by hysterectomy. In this study, endometrial ablation was performed successfully with the Hydro ThermAblator in 25 of 26 women. (J Am Assoc Gynecol Laparosc 6(3):275-278, 1999)

Uterine balloon therapy to treat menorrhagia

Objective: To study the clinical efficacy, safety and acceptability of the thermal balloon endometrial ablation (TBEA) in patients with dysfunctional uterine bleeding. Methods: Thirteen patients with DUB who did not respond to medical treatment and dilatation and curettage consented to a trial of TBEA with EASYTM model of balloon catheter by Gynecare. All procedures were done under intravenous (IV) sedation and paracervical block. Patients were mostly discharged within 48 h. Follow-up of 2–19 months is reported. Transvaginal ultrasound and hysteroscopy were performed in six patients after 6 months of TBEA. Results: Twelve patients (92.3%) reported a significant reduction in bleeding. Two patients (15.4%) experienced amenorrhea. Only two patients (15.4%) underwent subsequent hysterectomy, one for persistent menorrhagia and the other for severe pelvic pain. In successful patients of TBEA, transvaginal ultrasonography revealed marked reduction in endometrial thickness and no endometrium was visible in one patient who had developed amenorrhea. In successful cases follow-up hysteroscopy revealed scarring in more than two-thirds of the endometrium. Conclusions: Thermal balloon endometrial ablation is a safe, simple, effective, easy and minimally invasive procedure which can be done under IV sedation and paracervical block in an office setting. It has several advantages over hysterectomy, including preservation of the uterus, avoidance of surgical incision and potential to perform on an outpatient basis. It is a good alternative to hysteroscopic endometrial ablation with a comparable success rate with minimal risk and no limiting factors except the cost of the balloons. However, large scale randomized controlled studies are needed with TBEA and other endometrial ablation procedures.

Follow Up of Hysteroscopic Surgery for Menorrhagia

Division of Obstetrics and Gynaecology, Karolinska Institutet Danderyd Hospital, Danderyd, Sweden Acta Obstet Gynecol Scand 1998;77:435-438

Hysteroscopic endometrial ablation without endometrial preparation

Objective: To study the effectiveness of endometrial ablation by hysteroscopic resection without prior medical preparation for the treatment of women with persistent menorrhagia. Method: From January 1996 to January 1997, a total of 170 women with persistent menorrhagia and/or dysmenorrhea and who underwent hysteroscopic endometrial resection were included in the study. A thorough suction curettage was done before the procedure. The operation was conducted through a continuous flow hysteroscopic resectoscope with electrosurgery while the patient was under intravenous general anesthesia. The distention fluid used was 5% dextrose with a gravity feed infusion system consisting of a 2-l bag between 1 and 1.5 m above the uterine cavity. After the procedure, the patients' conditions were followed for at least 6–18 months by telephone interview or at our clinic. Results: A total of 127 women were available for a follow-up period of at least 6 months. Operative complications were 3%; three women had fever and received oral antibiotics; no uterine perforation occurred; one case of post-operative bleeding was controlled by intrauterine balloon inflation; the average operation time was 21 min; The mean fluid deficit was 435 ml. Ninety-nine out of 127 women (78%) had adequately controlled menorrhagia (18.1% had amenorrhea, 42.5% hypomenorrhea and 17.3% had normal menstrual flow), while 27 women (21.2%) were failed due to unchanged or heavier menstrual flow after surgery. Eleven (40%) out of the 27 failed cases had myoma with menorrhagia, whereas only five women (5%) out of the 99 adequately treated women had myomas ( P<0.05). Thirty-eight (54%) out of the 70 women with severe dysmenorrhea reported either lessening dysmenorrhea or no dysmenorrhea after the surgery. A total of 76 women (60%) were satisfied with the procedure. A second surgical procedure, either a resection or hysterectomy, was necessary in 13 women (10%) after ablation (seven received repeated ablations and six underwent hysterectomy). Conclusion: Endometrial ablation without endometrial suppression is a cheap, effective and acceptable procedure for treatment in women with persisted persistent menorrhagia.

Follow up of hysteroscopic surgery for menorrhagia

A retrospective study of short and long term results of transcervical endomyometrial resection for menorrhagia. Patient data were collected from all 104 premenopausal women who had undergone a transcervical endomyometrial resection due to severe menorrhagia in 1990-95. Almost 40% had submucous fibromas that were resected together with the endometrium. A questionnaire about gynecological symptoms was mailed to all 104 women. Ninety-seven (93%) women answered the questionnaire. The mean follow-up period was 29 months. The following short-term complications were encountered: fluid overload in four, one uterine perforation and one major bleeding. The long-term complications included: three hematometra and one pregnancy ending in a spontaneous abortion. Glandular hyperplasia of the endometrium without atypia was found in two cases, and adenomyosis in 31 (29%) cases. Twenty-one women (21%) became amenorrhoic after the treatment, whereas forty-nine (51%) had minimal menstrual bleeding. Eleven women (11%) suffered from dysmenorrhea. Due to dysmenorrhea and/or persistent menorrhagia thirteen (12.5%) underwent a hysterectomy, generally within one year after the resection. The histological examinations showed adenomyosis in three cases, fibromas in four and fibromas and adenomyosis in three cases. In our hands hysteroscopic transcervical endomyometrial resection was a safe and effective treatment for menorrhagia in spite of the fact that amenorrhea was not always achieved. However, dysmenorrhea appeared in 11% of the women. The reason for this remains to be studied. Correct selection criteria is important to get optimal results and reduce the treatment failure.

Hysterectomy Following Failed Endometrial Resection

Summary Of the ® rst 500 women in Oxford to undergo transcervical resection of the endometrium, 101 (20%) have subsequently undergone hysterectomy. This study was undertaken to assess the reasons for failure of endometrial resection. An audit of the case notes of the 101 women requiring hysterectomy was performed. Data collection included the patient’ s age, weight, parity, reasons for endometrial resection, details of the endometrial resection, reasons for hysterectomy, hysterectomy ® ndings and uterine histology. Six (6%) hysterectomies were performed as emergency operations during endometrial resection, 33 (33%) were performed for persistent menorrhagia, 39 (39%) for recurrent menorrhagia and in 18 women (18%) for pelvic pain. The duration of success following endometrial resection ranged from 0 to 21 months. Hysterectomy was signi® cantly more common in women under 40 years of age, in the presence of an enlarged ® broid uterus, when complications at endometrial resection had occurred and in women operated on by relatively inexperienced surgeons. Endometrium was present in 96% of hysterectomy specimens. Uterine malignancy that had not been diagnosed at transcervical resection of the endometrium was present at hysterectomy in two women. Hysterectomy should be considered in preference to endometrial resection for treatment of menorrhagia in women who are less than 40 years old and in the presence of large intramural ® broids.

Hysterectomy following failed endometrial resection

Of the first 500 women in Oxford to undergo transcervical resection of the endometrium, 101 (20%) have subsequently undergone hysterectomy. This study was undertaken to assess the reasons for failure of endometrial resection. An audit of the case notes of the 101 women requiring hysterectomy was performed. Data collection included the patient's age, weight, parity, reasons for endometrial resection, details of the endometrial resection, reasons for hysterectomy, hysterectomy findings and uterine histology. Six (6%) hysterectomies were performed as emergency operations during endometrial resection, 33 (33%) were performed for persistent menorrhagia, 39 (39%) for recurrent menorrhagia and in 18 women (18%) for pelvic pain. The duration of success following endometrial resection ranged from 0 to 21 months. Hysterectomy was significantly more common in older women under 40 years of age, in the presence of an enlarged fibroid uterus, when complications at endometrial resection had occurred and in women operated on by relatively inexperienced surgeons. Endometrium ws present in 96% of hysterectomy specimens. Uterine malignancy that had not been diagnosed at transcervical resection of the endometrium was present at hysterectomy in two women. Hysterectomy should be considered in preference to endometrial resection for treatment of menorrhagia in women who are less than 40 years old and in the presence of large intramural fibroids.

Uterine balloon therapy for the treatment of menorrhagia

From June 1994 to December 1995, 116 women (mean age 39 yrs, range 27-50 yrs) who met inclusion and exclusion criteria underwent endometrial ablation with a thermal balloon system. Forty-one (35%) were treated under general and 71 (61%) under neuroleptic anesthesia. Four (3%) treatments were performed under paracervical block only. A 16-cm long, 3-mm diameter catheter with a latex balloon at its tip housing a heating element was inserted into the uterus and filled with sterile 5% dextrose in water solution (mean 10.4 ml, range 2-55 ml). The catheter was connected to a control unit that maintained the temperature at 87 &plusmn; 5&deg; C, monitored the pressure, and terminated the treatment after 8 minutes. The starting uterine pressure was 80 to 140 mm Hg in the first 13 women and greater than 140 mm Hg in the rest. Nineteen women were treated for 12 minutes and all others for 8 minutes. Complications were endometritis (3), hematometra (2), and cystitis (1). At 6-month follow-up, after 8 minutes of treatment, persistent menorrhagia was reported by 38% and 12% of patients at less than and greater than 140 mm Hg pressure, respectively. At greater than 140 mm Hg pressure, menorrhagia was reported by 13% of women after 8 and 12 minutes of treatment. In 38 women, amenorrhea or spotting occurred in 29%, hypomenorrhea in 45%, eumenorrhea in 21%, and menorrhagia in 5%. Uterine balloon therapy is a safe and effective treatment for menorrhagia at uterine pressures of 150 to 180 mm Hg and of 8 minutes' duration.

The effect of methyl cyanoacrylate tissue adhesive on the human Fallopian tube and endometrium.

SummaryWhen the liquid tissue adhesive methyl‐2‐cyanoacrylate polymerized on the endometrium and Fallopian tube lining a temporary localized histotoxic effect was produced. The toxicity was confined to the superficial layers of cells which underwent round cell infiltration followed by fibrous tissue replacement with loss of the original epithelium. The thickness of secretory endometrium prevented damage to the basal layers and allowed the endometrium to regenerate. The basal layers of proliferative endometrium were involved in the inflammation and the endometrium did not regenerate. In the Fallopian tube the lining epithelium was permanently lost at all stages of the menstrual cycle and the tube lumen was obliterated. The polymer was eliminated from the genital tract within 16 weeks. The authors suggest that the transcervical technique of instillation described here may be developed (a) to control persistent menorrhagia, and (b) to offer a method of permanent sterilization in women comparable in ease to the insertion of an intrauterine contraceptive device.

MITRAL INSUFFICIENCY SECONDARY TO RUPTURED CHORDAE TENDINEAE. REPORT OF A SURGICALLY CORRECTED CASE.

RUPTURE of the mitral chordae tendineae, until recent years, has remained a medical curiosity and conversational material at clinical pathological conferences. With development of open heart surgery and cardiopulmonary bypass, surgical repair is now feasible. Mitral insufficiency may result from distortion of the mitral leaflet by ruptured chordae tendineae with loss of the normal valve restraining mechanism. The following communication presents a case of ruptured chordae secondary to subacute bacterial endocarditis with associated mitral insufficiency diagnosed preoperatively, and successfully corrected. Report of a Case The patient is a 38-year-old Caucasian female who was admitted on Nov 23, 1962 with the history of right parascapular pain. She had a dilatation and curettage performed because of menorrhagia in December, 1961. Because of persistent menorrhagia a hysterectomy was performed in October, 1962. During the course of her hospitalization she was examined by several physicians; no cardiac abnormalities were discovered. She had an uneventful