Transcervical Resection Of The Endometrium Research Articles

A randomized clinical trial to compare levonorgestrel-releasing intrauterine system (Mirena) vs trans-cervical endometrial resection for treatment of menorrhagia.

Objective:To compare the acceptability, efficacy, adverse effects, and user satisfaction of the levonorgestrel intrauterine system (LNG-IUS) and trans-cervical resection of the endometrium (TCRE) for the treatment of menorrhagia.Method:104 women with menorrhagia were divided into 2 groups: 52 women had the LNG-IUS inserted and 52 underwent TCRE. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, and rates of acceptability and satisfaction, were recorded at 6 and 12 months after the procedure.Results:After a year there were reductions of 93.9% and 88.4% in menstrual blood loss in the TCRE and LNG-IUS groups, respectively. Amenorrhea was more common in the TCRE group and spotting and systemic effects in the LNG-IUS group. Satisfaction rates of the TCRE group were higher than the LNG-IUS group (80.8% vs 69.2%), but the difference was not statistically significant.Conclusion:Although both treatments were found to be equally effective, LNG-IUS was less invasive and can be advised for younger women with a desire to preserve fertility.

Practical Tips for Office Hysteroscopy and Second-Generation “Global” Endometrial Ablation

Hysteroscopy and endometrial ablation using the second-generation devices are safe, generally well tolerated, and effective when performed in the medical office as opposed to the ambulatory surgery center or hospital operating room. Not only does this benefit the patient and physician in terms of convenience and cost savings, and the overall economic benefit to the health care system is great. The availability of modern hysteroscopic and video equipment, the advent of second-generation “global”endometrial ablation devices, and use of minimal sedation combined with effective local anesthesia have made office procedures possible. Several states have enacted specific regulations and requirements for office based surgery. It is incumbent on the physician to be aware of which local regulations are applicable and the level of procedure he or she is willing to perform before embarking on an office-based surgery program. The AAGL ListServ discussion forum provides members with an invaluable source of clinical opinion about patient care issues in minimally invasive gynecology. These opinions come from experts around the world representing both academic centers and clinical practice who respond to questions or issues posed by colleagues. This review discusses each of the second-generation endometrial ablation devices in detail and some of the more pertinent issues related to office hysteroscopy and global endometrial ablation that were posted on the ListServ. Rollerball and transcervical resection of the endometrium are not discussed because the overwhelming majority of these procedures are performed in the operating room and there is little potential for their becoming office procedures. Practical clinical tips based on the evidence in the literature are discussed.

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of 10 years

To compare outcomes and further operations at a minimum of 10 years following microwave endometrial ablation (MEA) or transcervical resection of the endometrium (TCRE). Follow up of a randomised controlled trial using postal questionnaires and operative databank review. Gynaecology department of a large UK teaching hospital. Women's satisfaction with treatment, menstrual symptoms, changes in health-related quality of life, and additional treatments received. One-hundred and eighty-nine of the original 263 women returned questionnaires (72%) after a minimum of 10 years post-treatment. Those totally or generally satisfied with treatment numbered 77/129 (60%) in the microwave arm and 70/134 (52%) in the resection arm, the difference is not statistically significant. Bleeding and pain scores were highly significantly reduced and similar following both MEA and TCRE, achieving amenorrhoea rates of 83 and 88% respectively. The hysterectomy rate after 10 years was significantly different with 22 (17%) in the MEA and 38 (28%) in the TCRE arm (95% CI: -0.21, -0.13). Both techniques achieve significant and comparable improvements in menstrual symptoms, health-related quality of life and high rates of satisfaction. With the known operative advantages, lower costs and fewer hysterectomies, it is clear that MEA is a more effective and efficient treatment for heavy menstrual loss than TCRE.

Comparison of the long‐term effects of simple total abdominal hysterectomy with transcervical endometrial resection on urinary incontinence

To test the hypothesis that the hospital referral rate for urinary incontinence (UI) symptoms, within 10 years of a simple total abdominal hysterectomy (TAH) for dysfunctional uterine bleeding (DUB), would differ to that after a transcervical resection of the endometrium (TCRE). Retrospective case note review. Teaching hospital in north east Scotland. All women who had a TAH (316) or a TCRE (229) for DUB, during the period from 1 January 1990 to 31 December 1994, who had never been referred for symptoms of UI prior to their operation. Independent t tests, Mann-Whitney U tests and Chi-squared tests were used to compare the two study groups in terms of demographic details and outcome measures. Newcombe's method for the comparison of two unpaired proportions was used to calculate 95% CIs for the differences in outcome measures between the two operations. Logistic regression was conducted to investigate associations with hospital referral for UI. Hospital referral for UI at 10 years follow up. There were significantly more hospital referrals for UI in the TAH group compared with the TCRE group (46 [15%] versus 16 [7%]; OR 2.27, 95% CI 1.25-4.12). More women were referred for urological investigations after a TAH than after a TCRE (39 [12%] versus 13 [6%], 95% CI for the difference in proportions 2-11%). A higher, but statistically nonsignificant, proportion of women had objectively demonstrated UI after a TAH than after a TCRE (25 [8%] versus 10 [4%], 95% CI for the difference in proportions -1 to 8%). There were a greater number of hospital referrals for treatment of UI in the TAH group (36, 11%) than in the TCRE group (12, 5%), 95% CI for the difference in proportions (1-11%). After adjusting for age, weight, smoking status and mode of delivery, the increased rate of hospital referral for UI after TAH remained, with an odds ratio of 2.31, 95% CI 1.24-4.30. TAH is associated with a significantly increased incidence of hospital referral for UI, urological investigations and treatment for UI at 10 years of follow up compared with TCRE.

Editors’ Choice

Editors’ Choice

The occurrence and outcome of 39 pregnancies after 1621 cases of transcervical resection of endometrium

To evaluate the outcomes and management of pregnancy after transcervical resection of the endometrium (TCRE). Retrospective study of 39 pregnancies after 1621 procedures of TCRE. Among 1621 women who were successfully followed up after TCRE, there were 39 pregnancies in 32 women, including five ectopic pregnancies (12.8%) and 34 intrauterine pregnancies (87.2%). The majority of pregnancies (84.6%) occurred within the first 2 years. In the first year after TCRE, the incidence of pregnancy was 1.5%. In women who had amenorrhoea after TCRE, the chances of conception (2/676; 0.3%) were significantly (P < 0.001) lower than for those who continued to have period (30/945; 3.2%). Thirty-two cases with intrauterine pregnancy were terminated under ultrasound guidance with two difficult procedures. Only one pregnancy in our study resulted in spontaneous miscarriage which was managed by suction curettage. One term pregnancy had placenta increta resulting in Caesarean hysterectomy. Pregnancies after TCRE are associated with increased risk, and clinicians should be aware of the various complications of pregnancy that may occur after TCRE, including an increased risk of ectopic pregnancy. Surgical termination of pregnancy after TCRE is potentially a difficult procedure and should be carried out under ultrasound guidance.

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding

Objective To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG-IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding. Method Of 50 women with a pictoral blood loss assessment chart (PBAC) score of 100 or greater, 25 had a LNG-IUS inserted (Mirena; Schering, Berlin, Germany) and 25 underwent TCRE. Procedure-related complications, PBAC score, hemoglobin levels, adverse effects, and rates of acceptability and satisfaction were recorded at 3-month intervals for a period of 12 months. Results At the end of 1 year there were a 97% and a 94% reduction in menstrual blood loss in the LNG-IUS and TCRE groups, respectively, and hemoglobin concentration had increased by 5.5% in the LNG-IUS group and 5.2% in the TCRE group. Adverse effects were similar in both groups except for systemic effects, which were seen only in the LNG-IUS group. Satisfaction rates were about 80% in the 2 groups. Conclusion Both treatments were found to be equally effective but LNG-IUS placement requires less operator skill and entails no operative hazards, and the device provides effective contraception.

A Randomized Comparison of Microwave Endometrial Ablation With Transcervical Resection of the Endometrium; Follow Up at a Minimum of Five Years

This paper presents a 5-year follow-up of a randomized, controlled trial, which compared microwave endometrial ablation (MEA) with transcervical resection of the endometrium (TCRE) for women with heavy menstrual bleeding. Two hundred sixty-three women were randomized to receive either MEA (n = 129) or TCRE (n = 134). For the current study, participants who were at least 60 months postprocedure were sent a questionnaire concerning satisfaction with and acceptability of their treatment method, menstrual status, changes in health-related quality of life, and any further surgery received. This was the same questionnaire that had been sent at 1- and 2-years of follow-up. Two hundred thirty-six of the original 263 study participants (90%) returned a completed questionnaire, including 116 MEA patients and 120 TCRE patients. Total or general satisfaction was reported by significantly more of those who underwent MEA compared with those who had TCRE (86% vs. 74%). Similarly, 83% and 75%, respectively, reported a cure or acceptable improvement in their symptoms, 97% and 91% expressed overall treatment acceptance, and 97% and 89% said that they would recommend the procedure to a friend. Both groups had similar, significant improvement in bleeding and pain scores, and 96% overall reported amenorrhea or lighter periods. Significantly more women in the TCRE group experienced dyspareunia compared with the MEA group (11% vs. 6%, respectively). Premenstrual symptoms improved significantly for both groups. Quality-of-life scores were improved for all participants. Disruptions to work or leisure activities were significantly lower in both treatment groups. In all, 24% of the patients who had MEA and 28% of those who had TCRE had undergone further gynecologic surgery in the follow-up period. This includes a 16% hysterectomy rate for the MEA cohort and 25% hysterectomy rate for women who had TCRE. Nearly all of the 20 hysterectomies among women in the MEA arm occurred within 24 months of the initial procedure. Reasons for hysterectomy were bleeding, combined bleeding and dysmenorrhea, cyclic pain, and miscellaneous conditions, including 1 woman in the TCRE arm who was operated on for endometrial carcinoma.

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow up at a minimum of five years

To compare long term outcomes following microwave endometrial ablation (MEA) or transcervical resection of the endometrium (TCRE). Follow up of a randomised controlled trial. Gynaecology department of a large UK teaching hospital. Two hundred and thirty-nine participants in a randomised comparison of MEA with TCRE. Collection of patient completed postal questionnaires and operative databank review. Women's satisfaction with and acceptability of treatment, menstrual symptoms, changes in health-related quality of life and additional treatments received. Two hundred and thirty-six of the original 263 women returned questionnaires (90%) after a minimum of five years post-treatment. Women allocated to MEA were significantly more likely to be totally or generally satisfied with treatment (86% vs 74%; difference 12%, 95% CI 2% to 23%), to find it acceptable (97% vs 91%; difference 6%, 95% CI 1% to 13%) and would recommend it (97% vs 89%; difference 8%, 95% CI 1% to 14%). Bleeding and pain scores were highly significantly reduced following both MEA and TCRE, achieving amenorrhoea rates of 65% and 69%, respectively. The hysterectomy rate after a minimum of five years was 16% in the MEA and 25% in the TCRE arm. Both techniques achieve significant and comparable improvements in menstrual symptoms, and health-related quality of life. While high rates of satisfaction with treatment and acceptability of treatment are achieved by TCRE, these are significantly lower than levels following MEA. These long term data, when combined with the trials' operative findings and known costs of both procedures, now inform us that MEA is a more effective and efficient treatment for heavy menstrual loss than TCRE.

Long-Term Treatment of Menorrhagia With Levonorgestrel Intrauterine System Versus Endometrial Resection

The purpose of this study was to compare the long-term efficacy of the levonorgestrel intrauterine system and transcervical resection of the endometrium in the treatment of menorrhagia. This study was an open, randomized 3-year trial. Patients with menorrhagia were assigned randomly to either the levonorgestrel intrauterine system (n = 30) or endometrial resection (n = 29). Pictorial blood loss assessment charts were used to measure menstrual blood loss. A pictorial blood-loss assessment chart score exceeding 75 (representing menstrual blood loss >/=60 mL) was used to diagnosis the patient as having menorrhagia. Discontinuations and cases requiring repeat operations were evaluated. Pictorial blood loss scores decreased from a baseline median of 261.5 (range, 60-1503) to 7 (range, 0-101; P < .001) for the levonorgestrel intrauterine system and from 311 (range, 81-2506) to 4 (range, 0-182; P < .001) for transcervical resection of the endometrium. Nineteen women of 30 using the levonorgestrel intrauterine system completed the 3-year follow-up compared with 22 of 29 for transcervical resection of the endometrium. Both treatments efficiently reduced menstrual bleeding. The high continuation rate suggests that the levonorgestrel intrauterine system is comparable with transcervical resection of the endometrium.

Mirena

Mirena is a levonorgestrel-releasing intrauterine system (LNG-IUS). It comprises a T-shaped plastic frame with a cylinder of the synthetic progestogen levonorgestrel that permits the slow and controlled release over 24 h of 20 μg levonorgesterel into the uterus. It was first approved in Finland in 1990 and approved by the FDA in 2001. Contraceptive effect is due to suppression of levonorgestrel on the endometrium, prevents sperm from reaching the egg. A cumulative pregnancy rate of 0.0–0.5 has been reported, which equals that of tubal ligation. Besides providing highly effective contraception, there are noncontraceptive benefits with Mirena. Noncontraceptive benefits include reduction in heavy menstrual bleeding, reduced growth of uterine fibroids, reduction in dysmenorrhoea and some benefits in the suppression of endometriosis. It is most suitable for older women of reproductive age when it can improve anovulatory dysfunctional bleeding. It can also act as the progestogen in hormone replacement therapy for postmenopausal women. Randomised studies of Mirena have been done comparing it with norethisterone, transcervical resection of the endometrium, endometrial ablation as well as hysterectomy. Irregular, breakthrough bleeding is the most common side effect and the most common reason for discontinuation. This occurs up to 6 months after use of Mirena. Other concerns include infection, ovarian cysts and ectopic pregnancy. The continuation rate for MIRENA was reported to be 0.65 at 5 years in Finnish women. Gross cumulative rates at 5 years per 100 women were for expulsion 5.9, removal for bleeding problems 16.7, removal for pain 4.3 and removal for pelvic inflammatory disease 1.2 in a UK study.

The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling.

To estimate the clinical effectiveness and cost-effectiveness of microwave endometrial ablation (MEA) and thermal balloon endometrial ablation (TBEA) for heavy menstrual bleeding (HMB), compared with the existing (first-generation) endometrial ablation (EA) techniques of transcervical resection (TCRE) and rollerball (RB) ablation, and hysterectomy. Electronic databases, bibliographies of articles, and also experts in the field and relevant industry bodies were asked to provide information. A detailed search strategy was carried out to identify systematic reviews and controlled trials of MEA and TBEA versus first-generation techniques for EA. In addition to electronic database searching, reference lists were hand-searched and information sought from manufacturers of EA devices and by experts in the field. A deterministic Markov model was developed to assess cost-effectiveness. Data for the model were taken from a range of sources. The systematic review of first-generation EA techniques versus hysterectomy found that EA offered an alternative to hysterectomy for HMB, with fewer complications and a shorter recovery period. Satisfaction and effectiveness were high for both MEA and TBEA. Costs were lower with EA although the difference narrows over time. Second-generation EA techniques are an alternative treatment to first-generation techniques for HMB, and first-generation techniques are known to offer an alternative to hysterectomy. Although no trials of second-generation techniques and hysterectomy have been undertaken, it seems reasonable to assume that second-generation techniques also offer an alternative surgical treatment. Using the model to assess cost-effectiveness, costs were very slightly higher for MEA when compared to TBEA, and differences in quality-adjusted life-years (QALYs) were negligible. For MEA compared with transcervical resection of the endometrium (TCRE) and RB ablation, costs were slightly lower with MEA and MEA accrued very slightly more QALYs. Compared with hysterectomy, MEA costs less and accrues slightly fewer QALYs. For TBEA compared with TCRE and RB ablation, costs were lower with TBEA and TBEA accrued slightly more QALYs. Compared with hysterectomy, TBEA costs moderately less and accrues moderately fewer QALYs. Overall, there were few significant differences between the outcomes of first- and second-generation techniques including bleeding, satisfaction and QoL measures and repeat surgery rates. Second-generation techniques had significantly shorter operating and theatre times and there appear to be fewer serious perioperative adverse effects with second-generation techniques and postoperative effects are similar. Compared with hysterectomy, TCRE and RB are quicker to perform and result in shorter hospitalisation and faster return to work. Hysterectomy results in more adverse effects and is more expensive, although the need for retreatment leads this difference to decrease over time. Satisfaction with hysterectomy is initially higher, but there is no significant difference after 2 years. The economic model suggests that second-generation techniques are more cost-effective than first-generation techniques of EA for HMB. Both TBEA and MEA appear to be less costly than hysterectomy, although the latter results in more QALYs. Further research is suggested to make direct comparisons of the cost-effectiveness of second-generation EA techniques, to carry out longer term follow-up for all methods of EA in RCTs, and to develop more sophisticated modelling studies. Further research is also recommended into HMB to establish health-state utility values, its surgical treatment, convalescence, complications of treatment, symptoms and patient satisfaction.

Transcervical Resection of Endometrium - Will it edge out Hysterectomy.

The most frequent indication for hysterectomy is menorrhagia, even though the uterus is normal in a large number of patients. Transcervical resection of the endometrium (TCRE) is a less drastic alternative, but success rates have varied and menorrhagia can recur. 60 patients with menorrhagia due to various causes who failed to respond to medical therapy and did not desire pregnancy and hysterectomy underwent TCRE with hysteroscope. 56 cases have been followed up postoperatively for 3 years. The primary endpoints were women's satisfaction and need for further surgery. The proportion of patients who attained amennorhea 24 months after the procedure was 44.4% and the percentage of patients who attained hypomennorhea was 44.4%. The patients satisfaction rate after 24 months of follow up was 88.8%. Failure of TCRE procedure was encountered in 6.6% of patients. Randomized comparison with hysterectomy has shown short-term benefits in the form of shorter operating time, fewer complications and faster rates of recovery and almost as high satisfaction levels. TCRE is an effective procedure in treating menorrhagia and is an acceptable alternative to medical management and hysterectomy in the treatment of menorrhagia for many women with no other serious disorders.

Repeat Hysteroscopic Surgery Reduces the Hysterectomy Rate after Endometrial and Myoma Resection

Study Objective To assess the efficacy of repeat transcervical resection of the endometrium (TCRE) in patients with dysfunctional uterine bleeding and myomas in whom primary resection failed. Design Retrospective analysis (Canadian Task Force classification III). Setting University hospital endoscopic unit. Patients Six hundred sixty-eight women. Intervention Repeat TCRE or transcervical resection of a myoma (TCRM). Measurements and Main Results Of 668 patients, 118 (17%) required repeat resection for the following reasons: pain (52, 44%), menorrhagia (39, 31%), myomas (15, 13%), perforation at the primary TCRE (6, 5%), and large fluid deficit during the procedure (6, 5%). Of 118 women undergoing repeat TCRE or TCRM, 33 (28%) eventually required hysterectomy due to pain (17, 48%), persistent bleeding (7, 27%), pain and bleeding (3, 10%), regrowth of myomas (3, 14%), and other reasons (3, 14%). Conclusion Repeat resection is an option after failed primary hysteroscopic operation and may reduce the hysterectomy rate.

Advances in endometrial ablation.

The evolution of the surgical treatment of dysfunctional uterine bleeding has resulted in the design and manufacture of instrumentation that is minimally invasive, has a low risk profile, and is technically simple to operate. Whereas hysterectomy was the only definitive surgical option before 1981, operative hysteroscopy with transcervical resection of the endometrium and rollerball ablation of the endometrium gained favor in the mid-1980s and 1990s. During the past 10 years, devices dedicated entirely to the ablation (or destruction) of the endometrium have been designed, modeled, tested, and approved for clinical use in the United States. This review describes the methods by which the technologies are evaluated and approved for clinical use by the Food and Drug Administration. In addition, the reported efficacy of each approved device is reviewed. The complications associated with the devices, as well as the potential long-term risks of endometrial ablation, also are reported. Finally, the cost for device disposables and nondisposables is presented. Obstetricians & Gynecologists, Family Physicians After completion of this article, the reader will be able to list the various FDA-approved uterine ablation devices, compare the effectiveness of the various uterine ablation devices, and summarize the various adverse events associated with the use of the uterine ablation devices.

Transcervical endometrial resection: is it really a simple solution for a major problem?

ABSTRACTObjectives To determine the long‐term efficacy of transcervical resection of the endometrium (TCRE).Design Prospective long‐term follow‐up study.Setting Academic practice tertiary care setting.Patients 116 concecutive women undergoing endometrial resection because of menorrhagia, who wished to retain the uterus.Intervention Hysteroscopic endometrial resection performed as a day procedure.Main outcome measures Long‐term assessment was on the basis of menstrual symptoms and patient satisfaction, and a questionnaire was used that included open‐ended and closed questions.Results 116 endometrial resections were carried out. The satisfaction rate varied from 75% to 70% over 5 years. At 1 year, 40% of women were amenorrhoeic. Larger uterine size, young age and adenomyosis were factors associated with negative outcomes. After initial TCRE, 20 women required further surgery, menorrhagia being the most common indication.Conclusion Although the use of TCRE to treat menorrhagia did not avoid the need for hysterectomy in all women, for those considering hysterectomy, it was an alternative procedure that was conservative, had low morbidity and provided a good chance of avoiding the need for major surgery, especially when performed by an experienced surgeon to treat women over the age of 45.

Transcervical resection of the endometrium and myometrium: a review of 111 patients after 6 years

Objective To determine the medium- to long-term amenorrhoea rate and patient satisfaction following transcervical resection of both the endometrium and inner myometrium (TCREM). Design A prospective audit of 111 patients. Subjects 111 patients referred with menorrhagia, and concomitant dysmenorrhoea in 74% of cases. Setting Queen Charlotte's and Chelsea Hospital for Women, London. Methods Data relating to patient history, operational details, subsequent bleeding and pain, satisfaction and complications, were obtained from a pro forma, case notes and an annual questionnaire with a menstrual calendar. The patients were followed up for six full years. Results 103 women (93%) completed the audit. By the sixth year of follow up 78% of the women were satisfied with the result of their TCREM, 64% being amenorrhoeic. Conclusion Resection of both the endometrium and inner myometrium appears to offer an improved amenorrhoea rate compared with resection of the endometrium alone. Patient satisfaction is high and there was no apparent increase in morbidity. This applied to women with both menorrhagia and dysmenorrhoea.

Transcervical endometrial resection in 197 women. Hysterectomy rate and associated risk factors after a 5–8‐year follow‐up period

ABSTRACTObjective To identify the hysterectomy rate and associated factors following transcervical resection of the endometrium (TCRE).Design Prospective observational study over an 8‐year period.Setting Endoscopic Unit and Medical Audit Department, Derriford Hospital, Plymouth, UK.Sample The first 197 women to undergo TCRE for menstrual disorders under the care of the senior author (J.M.F.).Interventions Hysteroscopic endometrial resection and rollerball ablation.Main outcome measure Hysterectomy rate.Results All women were followed up from a minimum of 5 to a maximum of 8 years. The mean age was 41 years (range 24–56). The procedure was abandoned in three cases. There were no deaths. Immediate complications occurred in 5% of patients (including five uterine perforations and one case of deep venous thrombosis). No serious fluid overload sequelae occurred. There was one case of atypical endometrial hyperplasia, but no cancer was found. At the end of the study (median follow up of 72 months), survival analysis showed that the hysterectomy rate because of persistent menstrual complaints was 25%. Five hysterectomies were done because of uterine perforation at the time of TCRE and four for unrelated reasons. Multivariate analysis identified only blood loss at TCRE as an independent risk factor for hysterectomy. Other operative variables (age, surgeon, size of uterus, presence of fibroids, volume of glycine used, operating time, synchronous laparoscopic sterilization, and repeat TCRE) had no effect on the hysterectomy risk.Conclusions Our results indicate that women who are offered a TCRE should be warned that they have a one‐in‐four risk of subsequently having a hysterectomy for persistent menstrual complaints. However, TCRE is a quick, safe operation with minimal operative morbidity. A repeat TCRE and the presence of fibroids did not increase the risk of hysterectomy in this group of women.

Microwave endometrial ablation versus transcervical resection of the endometrium

Microwave endometrial ablation versus transcervical resection of the endometrium

Treatment of menorrhagia before hysterectomy in a district general hospital. A retrospective review

Between March 1996 and March 1998 236 women had a hysterectomy at Tameside District General Hospital. Of these, women, the indication in 132 was idiopathic menorrhagia and their treatments before hysterectomy were reviewed. It was found that luteal phase progestogens were the drug treatment of choice for menorrhagia by the general practitioners (GPs) and hospital doctors (46% and 40·5%, respectively). Fifty-two (39%) of the women had no medical treatment before hysterectomy while 38 (29%) had only one type of drug treatment. The decision to perform a hysterectomy was taken at the first clinic visit in 40 (30%) of the women and in 77 (58%) of them by the second visit. Transcervical resection of the endometrium (TCRE) was tried in 11% of the women, while none had the levonorgestrel impregnated intrauterine system (Mirena IUS) fitted. Objective assessment of menstrual loss was not performed before treatment. Our data suggest an early recourse to hysterectomy in the treatment of idiopathic menorrhagia and the hypothesis that hysterectomy follows failure of appropriate medical and alternative treatment of menorrhagia was not confirmed.