Second-generation Endometrial Ablation Research Articles

First and second-generation endometrial ablation devices: A network meta-analysis

ObjectiveFirst-generation and second-generation endometrial ablation (EA) techniques, along with medical treatment and invasive surgery, are considered successful lines of management for abnormal uterine bleeding (AUB). We set out to determine...

Ultrasound Appearance of the Endometrium Post-Radiofrequency Ablation.

To describe the ultrasonographic appearance of the post-ablative endometrium to improve knowledge of its sonographic findings. This was an Institutional Review Board approved prospective study of patients who underwent second-generation endometrial ablation from 2016 to 2019 at a single health system. Patients had postoperative transvaginal ultrasounds at 2, 6, and 12 months. Ultrasound reports were analyzed for endometrial thickness, description of the endometrium and myometrium, presence of uterine fibroids, and uterine size. Statistical tests for repeated measures were utilized. There were 68 patients with the average age of 42 (SD 6) years and a BMI of 33 (SD 8). Preoperatively the average endometrial thickness was 10 mm, uterine length was 9.7 cm, and 38.2% had leiomyoma. The average endometrial thickness decreased at each ultrasound: 8.4 mm (SD 3.4), 7.2 mm (SD 3.0), and 5.8 mm (SD 2.5) at 2, 6, and 12 months, respectively. When comparing endometrial thickness postoperatively there was a significant difference at 2 and 12 months (P = .041), and 6 and 12 months (P = .031). There was no change during the postoperative period in the presence of leiomyoma, hyperechoic endometrium, hypoechoic endometrium, heterogeneous endometrium, and cystic endometrium on the ultrasounds. After ablation with a second-generation device, the endometrial thickness on ultrasound decreases with time following surgery. Additional studies correlating these findings to clinical outcomes would be useful.

Treatment Failure Rates of Second-Generation Endometrial Ablation Devices in Premenopausal Women with BMI≥35 Kg/m2

<h3>Study Objective</h3> To investigate the treatment failure rates of second-generation endometrial ablation (EA) devices in obese women with BMI≥35 kg/m² in a multi-site single health care system. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Academic community health care system. <h3>Patients or Participants</h3> Premenopausal women aged 18-51 years old who underwent second-generation endometrial ablation for benign indications. <h3>Interventions</h3> Women underwent Radiofrequency Ablation (RFA), Hydrothermal Ablation, Uterine Balloon Ablation, or Combined Argon/RFA Ablation between January 2010 to December 2020. <h3>Measurements and Main Results</h3> 1328 women were identified who underwent second-generation EA of which 1198 patients met criteria. Failure was defined as re-intervention via repeat EA or hysterectomy for persistent uterine bleeding. The overall EA failure rate was 13.9%, with a total of 167 women who required a re-intervention. The proportion of women with BMI<35 kg/m² vs BMI≥35 kg/m² who had a re-intervention was 12.3% vs 17.6% (p=0.019), with an odds ratio of 1.520 (95% CI: 1.083-2.132). Common preoperative diagnoses for re-intervention were abnormal uterine bleeding (73.7%), pelvic pain (50.3%), and fibroid (29.9%). Significant findings on pathology reports after re-intervention showed adenomyosis (44.9%) and fibroids (40.7%). The median time lapse between initial EA and re-intervention was 477 days. <h3>Conclusion</h3> Obesity (BMI≥35 kg/m²) is a risk factor for failure of an endometrial ablation procedure. These findings may be helpful in determining appropriate candidates for this treatment option, as well as improving counseling on possible failure and subsequent risk of re-intervention after an endometrial ablation.

Outpatient endometrial ablation: audit of outcomes and patient satisfaction

Endometrial ablation in outpatient setting is associated with shorter hospital stay and quicker recovery. The primary outcome of this observational study was initiation and completion of procedure and secondary outcome measures were pain during the procedure and complications. The study was conducted in outpatient women’s health clinic of Bolton Foundation NHS Trust UK, between March 2015 and July 2017. Out of 151 patients, all had oral analgesia at home. The procedure was initiated and completed in 83% cases. The median time for procedure was 78.5 s with range (34–120 s). The median intraoperative and immediate post-op pain score was 8 and 2, respectively. Post-procedure hysteroscopy confirmed intact cavity in all. Post-op analgesia was required in 2% cases. Eight-nine percent were discharged immediately, 10% had to be rested and observed for 30–60 min. None had serious complications. Ninety percent were satisfied with outpatient service and would recommend to friends and family.Impact StatementWhat is already known on this subject? Second-generation endometrial ablation is an effective first-line management option for heavy menstrual bleeding. Outpatient procedure is associated with shorter hospital stay, quicker recovery and avoids general anaesthesia and its complications.What do the results of this study add? This observational study confirmed that it was suitable to start the procedure in 83% cases. Once started, it was possible to complete in 100%. The most common cause for not being able to start the procedure was intolerability to the patients. The median immediate post-procedure pain score was 2 which was highly acceptable to patients. 90% of patients who underwent the outpatient endometrial ablation would choose to have further hysteroscopic procedures as outpatient.What are the implications of these findings for clinical practice and/or further research? Patients should be given choice for endometrial ablation either with or without general anaesthesia. Patients should be carefully selected for outpatient procedure taking into account informed consent, tolerability of speculum examination and endometrial pipelle biopsy as well as understanding anticipation of some discomfort. Further randomised controlled trials should be carried out to determine patient satisfaction with endometrial ablation with or without general anaesthesia.

Prognostic Factors for the Failure of Endometrial Ablation: A Systematic Review and Meta-analysis.

To provide an overview of prognostic factors predicting failure of second-generation endometrial ablation. MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov were systematically searched from 1988 until February 2019. The search was conducted without language restrictions using the following search terms: "endometrial ablation," "prognosis," "predict," "long term," "late onset," "outcome." The literature search provided a total of 990 studies. All types of studies reporting about prognostic factors of second-generation endometrial ablation failure were included. After screening for eligibility, 56 studies were included in this review, of which 21 were included in the meta-analysis. In these 56 studies, 157,830 women were included. We evaluated 10 prognostic factors: age, myomas, history of tubal ligation, body mass index, parity, preexisting dysmenorrhea, caesarean delivery, bleeding pattern, uterus position, and uterus length. Meta-analysis was performed for the primary outcome (surgical reintervention) to estimate summary treatment effects. Younger age (aged 35 years or younger, odds ratio [OR] 1.68, 95% CI 1.19-2.36; aged 40 years or younger, OR 1.58, 95% CI 1.30-1.93; aged 45 years or younger OR 1.63, 95% CI 1.28-2.07), prior tubal ligation (OR 1.46, 95% CI 1.23-1.73), and preexisting dysmenorrhea (OR 2.12, 95% CI 1.41-3.19) were associated with an increased risk of surgical reintervention. Studies investigating the prognostic factors myomas and obesity showed conflicting results. Younger age, prior tubal ligation and preexisting dysmenorrhea were found to be associated with failure of endometrial ablation. Obesity and the presence of large submucous myomas may be associated with failure, as well, though more research is necessary to estimate the influence of these factors. It is important to take the results of this review into account when counselling women with heavy menstrual bleeding. PROSPERO, CRD42019126247.

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

HEALTH: laparoscopic supracervical hysterectomy versus second-generation endometrial ablation for the treatment of heavy menstrual bleeding: study protocol for a randomised controlled trial

BackgroundHeavy menstrual bleeding (HMB) is a common problem affecting approximately 1.5 million women in England and Wales with a major impact on their physical, emotional, social and material quality of life. It is the fourth most common reason why women attend gynaecology outpatient clinics and accounts for one-fifth of all gynaecology outpatient referrals. Initial treatment in primary care is medical - either by means of oral or injected medication or the levonorgestrel-intrauterine system (Mirena®). If medical treatment fails then surgical treatment can be offered, either endometrial ablation (EA), which destroys the lining of the cavity of the uterus (endometrium), or hysterectomy, i.e. surgical removal of the uterus.While effective, conventional hysterectomy is invasive and carries a risk of complications due to injury to other pelvic structures. The procedure can be simplified and complications minimised by undertaking a ‘supracervical’ hysterectomy where the cervix is left in situ and only the body of the uterus removed. Recent advances in endoscopic technologies have facilitated increased use of laparoscopic supracervical hysterectomy (LASH) which can be performed as a day-case procedure and is relatively easy for the surgeon to learn.HEALTH (Hysterectomy or Endometrial AbLation Trial for Heavy menstrual bleeding) aims to address the question ‘Is LASH superior to second generation EA for the treatment of HMB in terms of clinical and cost effectiveness?’Methods/DesignWomen aged < 50 years, with HMB, in whom medical treatment has failed and who are eligible for EA will be considered for trial entry. We aim to recruit women from approximately 30 active secondary care centres in the UK NHS who carry out both surgical procedures. All women who consent will complete a diary of pain symptoms from day 1 to day 14 after surgery, postal questionnaires at six weeks and six months after surgery and 15 months post randomisation. Healthcare utilisation questions will also be completed at the six-week, six-month and 15-month time-points.DiscussionMeasuring the comparative effectiveness of LASH vs EA will provide the robust evidence required to determine whether the new technique should be adopted widely in the NHS.Trial registrationInternational Standard Randomised Controlled Trials, ISRCTN49013893. Registered on 28 January 2014.

Incidence and predictors of failed second-generation endometrial ablation

BackgroundThe need for any treatment following an endometrial ablation is frequently cited as “failed therapy,” with the two most common secondary interventions being repeat ablation and hysterectomy. Since second-generation devices have become standard of care, no large cohort study has assessed treatment outcomes with regard to only these newer devices. We sought to determine the incidence and predictors of failed second-generation endometrial ablation, defined as the need for surgical re-intervention.We performed a retrospective cohort study at a single academic-affiliated community hospital. Subjects included women undergoing second-generation endometrial ablation for benign indications between October 2003 and March 2016. Second-generation devices utilized during the study period included the radiofrequency ablation device (RFA), hydrothermal ablation device (HTA), and the uterine balloon ablation system (UBA).ResultsFive thousand nine hundred thirty-six women underwent endometrial ablation at a single institution (3757 RFA (63.3%), 1848 HTA (31.1%), and 331 UBA (5.6%)). The primary outcome assessed was surgical re-intervention, defined as hysterectomy or repeat endometrial ablation. Of the total 927 (15.6%) women who required re-intervention, 822 (13.9%) underwent hysterectomy and 105 (1.8%) underwent repeat endometrial ablation. Women who underwent re-intervention were younger (41.6 versus 42.9 years, p < .001), were more often African-American (21.8% versus 16.2%, p < .001), and were more likely to have had a primary radiofrequency ablation procedure (hazard ratio 1.37; 95%CI 1.01 to 1.86). Older age was associated with decreased risk for treatment failure with women older than 45 years of age having the lowest risk for failure (p < .001). Age between 35 and 40 years conferred the highest risk of treatment failure (HR 1.59, 95% CI 1.32–1.92). Indications for re-intervention following ablation included menorrhagia (81.8%), abnormal uterine bleeding (27.8%), polyps/fibroids (18.7%), and pain (9.5%).ConclusionSurgical re-intervention was required in 15.6% of women who underwent second-generation endometrial ablation. Age, ethnicity, and radiofrequency ablation were significant risk factors for failed endometrial ablation, and menorrhagia was the leading indication for re-intervention.

Utility of anesthetic block for endometrial ablation pain: arandomized controlled trial.

Second-generation endometrial ablation has been demonstrated safe for abnormal uterine bleeding treatment, in premenopausal women who have completed childbearing, in short-stay surgical centers and in physicians' offices. However, no standard regarding anesthesia exists, and practice varies depending on physician or patient preference and hospital policy and setting. The aim of this study was to evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain and associated narcotic use following endometrial ablation. This was a single-center single-blind randomized controlled trial conducted in an academic-affiliated community hospital. A total of 84 English-speaking premenopausal women, aged 30 to 55 years, who were undergoing outpatient endometrial ablation for benign disease were randomized to receive standardized paracervical injection of 20 mL 0.25% bupivacaine (treatment group) or 20 mL normal saline solution (control group) upon completion of ablation. The study was designed to test a 40% 1-hour mean visual analog scale (VAS) pain score difference with an average standard deviation of 75% of both groups' mean VAS scores, using a 2-tailed test, a type I error of 5%, and statistical power of 80%. A sample of 36 patients per study group was required. Assuming a 15% attrition rate, the study enrolled 42 patients per study arm randomized in blocks of 2 (84 total). Two-tailed cross-tabulations with Fisher exact significance values where appropriate and Student t tests were used to compare patient characteristics. Backward stepwise regressions were conducted to control for confounding. Between April 2016 and February 2017, a total of 108 women scheduled for endometrial ablation were screened (refusals, n= 21; ineligible, n= 3) to determine whether there were meaningful differences in postoperative VAS pain scores and postoperative narcotic use. Of the 84 randomized women, 2 age-ineligible women were excluded. Intent-to-treat analyses included 1 incorrect randomization (in which the provider consciously decided to provide analgesia regardless of the protocol, after which the provider was excluded from further study participation) and 3 women having no ablation because of operative difficulties. Three were lost to second-day follow-up. Treatment group patients (n= 41) experienced 1.3 points lower 1-hour postoperative VAS pain scores than the control group (n= 41, P= .02). The difference diminished by 4 hours (P= .31) and was negligible by 8 hours (P= .62). Treatment group patients used 3.6 less morphine equivalents of postoperative pain medication (P= .05). Regression analyses controlled for confounding reduced the 1-hour postoperative treatment group pain scoredifference to 0.8 (confidence interval [CI],-0.6 to 0.1) but slightly increased theaverage postoperative morphine equivalents to 3.7 (CI,-6.8 to-0.7). This randomized controlled trial found that local anesthetic with low risk for complications, used in conjunction with general anesthesia, decreased postoperative pain at 1 hour and significantly reduced postoperative narcotic use following endometrial ablation. Further research is needed to determine whether the study results are generalizable and whether post procedure is the best timeto administer the paracervical block to decrease endometrial ablation pain.

389 - Utility of Anesthetic Block for Endometrial Ablation Pain: A Randomized Controlled Trial

Background Second-generation endometrial ablation has been demonstrated safe for abnormal uterine bleeding treatment, in premenopausal women who have completed childbearing, in short-stay surgical centers and in physicians’ offices. However, no standard regarding anesthesia exists, and practice varies depending on physician or patient preference and hospital policy and setting. Objective The aim of this study was to evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain and associated narcotic use following endometrial ablation. Materials and Methods This was a single-center single-blind randomized controlled trial conducted in an academic-affiliated community hospital. A total of 84 English-speaking premenopausal women, aged 30 to 55 years, who were undergoing outpatient endometrial ablation for benign disease were randomized to receive standardized paracervical injection of 20 mL 0.25% bupivacaine (treatment group) or 20 mL normal saline solution (control group) upon completion of ablation. The study was designed to test a 40% 1-hour mean visual analog scale (VAS) pain score difference with an average standard deviation of 75% of both groups’ mean VAS scores, using a 2-tailed test, a type I error of 5%, and statistical power of 80%. A sample of 36 patients per study group was required. Assuming a 15% attrition rate, the study enrolled 42 patients per study arm randomized in blocks of 2 (84 total). Two-tailed cross-tabulations with Fisher exact significance values where appropriate and Student t tests were used to compare patient characteristics. Backward stepwise regressions were conducted to control for confounding. Results Between April 2016 and February 2017, a total of 108 women scheduled for endometrial ablation were screened (refusals, n = 21; ineligible, n = 3) to determine whether there were meaningful differences in postoperative VAS pain scores and postoperative narcotic use. Of the 84 randomized women, 2 age-ineligible women were excluded. Intent-to-treat analyses included 1 incorrect randomization (in which the provider consciously decided to provide analgesia regardless of the protocol, after which the provider was excluded from further study participation) and 3 women having no ablation because of operative difficulties. Three were lost to second-day follow-up. Treatment group patients (n = 41) experienced 1.3 points lower 1-hour postoperative VAS pain scores than the control group (n = 41, P = .02). The difference diminished by 4 hours (P = .31) and was negligible by 8 hours (P = .62). Treatment group patients used 3.6 less morphine equivalents of postoperative pain medication (P = .05). Regression analyses controlled for confounding reduced the 1-hour postoperative treatment group pain score difference to 0.8 (confidence interval [CI], −0.6 to 0.1) but slightly increased the average postoperative morphine equivalents to 3.7 (CI, −6.8 to −0.7). Conclusion This randomized controlled trial found that local anesthetic with low risk for complications, used in conjunction with general anesthesia, decreased postoperative pain at 1 hour and significantly reduced postoperative narcotic use following endometrial ablation. Further research is needed to determine whether the study results are generalizable and whether post procedure is the best time to administer the paracervical block to decrease endometrial ablation pain.

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

Impact of Levonorgestrel Intrauterine Device on Endometrial Ablation Utilization for Treatment of Menorrhagia

Abstract Objective: The aim of this research was to determine changes in endometrial ablation utilization following Food and Drug Administration (FDA) approval of the levonorgestrel–intrauterine device (IUD) for treatment of menorrhagia. Materials and Methods: This was a cohort study. All women who had undergone second-generation endometrial ablation or levonorgestrel-IUD placement for treatment of menorrhagia between January of 2009 and December of 2013 were considered for inclusion. Women's cases were excluded if the primary indication for treatment was not menorrhagia or if outpatient evaluation and treatment records were not available for review. Results: A total of 333 cases met study inclusion criteria, including the women who had undergone endometrial ablation (n = 204) or levonorgestrel-IUD placement (n = 129). The primary outcome measured was the number of patients who underwent endometrial ablation or levonorgestrel-IUD placement prior to and following FDA approval of the levonorgestrel-IUD for ...

Is the Pictorial Blood Loss Assessment Chart(PBAC) score associated with treatment outcome after endometrial ablation for heavy menstrual bleeding? A cohort study.

The Pictorial Blood Loss Assessment Chart(PBAC) is a validated tool that is used to diagnose heavy menstrual bleeding (HMB). Knowledge of the effect of its score and its relationship with outcome could have implications for using the PBAC as an outcome measurement in future HMB studies, and as a tool to evaluate the treatment effect in research and clinical practice. Our aim was to relate PBAC scores to other measures of success after endometrial ablation for HMB. Analysis of individual patient data (IPD) of randomised controlled trials studying women with HMB. Women with HMB consulting their gynecologists. Individual patient data (IPD) of randomised controlled trials studying women with HMB. We included studies if they had studied second-generation endometrial ablation techniques and had collected PBAC scores for both baseline and follow-up. The effectiveness of treatment was scored as satisfaction or re-intervention (yes/no) 12months after treatment. We related these outcomes to the PBAC score at 12months after treatment, and to PBAC decrease between baseline and 12months of follow-up. We studied data for 900 patients included in nine studies. The median PBAC score at 12months was 7 (0-2500). The overall satisfaction rate was 89% and the overall re-intervention rate was 7.2%. A clear association was found between absolute PBAC score at the 12-month follow-up and satisfaction (odds ratio, OR0.16; 95% confidence interval, 95%CI 0.11-0.24) and surgical re-intervention (OR2.3, 95%CI 1.8-2.8). A change in PBAC score was also associated with satisfaction (OR2.0, 95%CI 1.7-2.3) and surgical re-intervention (OR0.69, 95%CI 0.63-0.75). Both the absolute PBAC scores and the changes in score show high accuracy for both treatment outcomes. PBAC scores at 12months after treatment are significantly associated with satisfaction and re-intervention rates. We propose to use the PBAC in research as a primary end point in studies on HMB, and in clinical practice as a measure to assess the effectiveness of treatment. PBAC scores 12months after treatment are significantly associated with satisfaction and reintervention rates.

Ambulatory management of heavy menstrual bleeding.

Heavy menstrual bleeding (HMB) has significant adverse effects on the quality of life of many women, placing an economic burden on both health services and society at large. Thus, it is essential that all women with HMB have easy access to the proper diagnostic and therapeutic work-up in an outpatient fashion, avoiding the more time-consuming inpatient management. This new outpatient approach for HMB is one of the latest development of gynecological practice and can offer both diagnostic and therapeutic procedures. This manuscript aims to show the current possibilities of the modern management of HMB, which can be safely and effectively accomplished in the outpatient setting: global and directed endometrial biopsy, levonorgestrel intrauterine system insertion as well as minimally invasive surgical procedures (encompassing a variety of operative hysteroscopic procedures and second-generation endometrial ablation) are described below.

Hysteroscopy and heavy menstrual bleeding (to cover TCRE and second-generation endometrial ablation)

Endometrial resection and ablation are an intermediate treatment for heavy menstrual bleeding (HMB). Many women do not like the continuous use of hormones, nor do they prefer a rigorous treatment as hysterectomy. The first generation of endometrial resection/ablation is now superseded by the second-generation endometrial ablation. Both seem to be equally effective in reducing HMB, and there was no evidence that rates of satisfaction differed significantly. Overall, second-generation techniques were often easier to perform with shorter surgery times and the ability to use local rather than general anaesthesia. Complications seem to be less after second-generation endometrial ablation; however, the easiness of use can be a pitfall. Prognostic parameters should be taken into account while counselling women who opt for an endometrial ablation. The most important prognostic parameters are age (satisfaction increases with age) and preoperative dysmenorrhoea (decreases satisfaction).

When second-generation endometrial ablation fails—a review of 200 cases of endometrial ablation

Menorrhagia is the most common reason for gynaecological consultation in the UK [1]. Historically, when medical therapy for menorrhagia failed, hysterectomywas the primary surgical option. Endometrial ablation has emerged as a minimally invasive alternative to hysterectomy. Newer ‘second-generat ion ’ endomet r i a l ab la t ion techn iques such as THERMACHOICE® and NovaSure® have been developed. Published reports focus primarily on first-generation methods and describe a wide range of hysterectomy rates ranging from 8–29 % [2–9]. To improve our knowledge of how to best counsel patients considering endometrial ablation, we conducted a retrospective review analysis of patients who underwent second-generation endometrial ablation. Our goal was to estimate the relative importance of age of onset of menorrhagia, BMI, parity, presence of dysmenorrhoea, previous normal vaginal deliveries/caesarean sections, and type of endometrial ablation in predicting endometrial ablation failure as defined by subsequent hysterectomy.

First- Versus Second-Generation Endometrial Ablation Devices for Treatment of Menorrhagia: A Systematic Review, Meta-Analysis and Appraisal of Economic Evaluations

ObjectiveTo estimate the clinical and economic effect of using second-generation endometrial ablation devices compared to first-generation devices for treatment of menorrhagia in pre-menopausal women. The secondary objective was to compare the second-generation devices with one another. Data SourcesWe searched Medline and EMBASE, and other sources of unpublished literature, and screened references from relevant articles. Study SelectionWe included only randomized controlled trials or full economic evaluations of premenopausal women with menorrhagia undergoing endometrial ablation using first-generation compared with second-generation devices. Data Extraction and Data SynthesisData extraction and risk of bias assessment was carried out for all clinical studies, and data were pooled using the random effects model. A qualitative narrative synthesis was used to combine results from the economic review. Eleven studies met eligibility criteria (n = 1679). There was no difference in the rate of amenorrhea between first- and second-generation ablation (5 studies with 998 patients, rate ratio 1.15, 95% CI 0.96 to 1.38; P = 0.14), but second-generation devices had a lower complication rate (7 studies with 1272 patients, rate ratio 0.52, 95% CI 0.35 to 0.76; P < 0.001), decreased operating time by 16.6 minutes (3 studies with 486 patients, 95% CI 12.1 to 21.2 minutes; P < 0.001), and could more commonly be used with local anaesthesia (3 studies with 558 patients, rate ratio 1.87, 95% CI 1.04 to 3.37; P = 0.04). There was a higher rate of amenorrhea in patients treated with Novasure than with other second-generation devices (4 studies with 407 patients, rate ratio 2.60, 95% CI 1.63 to 4.14; P < 0.001). Three European studies were included in the economic synthesis, which found that second-generation devices were more cost-effective than first-generation devices. ConclusionSecond-generation endometrial ablation devices seem to be as effective as first-generation devices but likely reduce operating time, can be used more often with local anaesthesia, and have fewer complications. They also seem to be more cost-effective than first-generation devices, but further economic evaluations need to be carried out in Canada.

First- Versus Second-Generation Endometrial Ablation for Treatment of Menorrhagia: A Health Technology Assessment

First- Versus Second-Generation Endometrial Ablation for Treatment of Menorrhagia: A Health Technology Assessment