Endometrial ablation is a less invasive treatment for menorrhagia than is hysterectomy, and it preserves the uterus. This randomized controlled trial was undertaken to assess 10-year outcomes for 2 established methods of endometrial ablation in 120 women with heavy dysfunctional ablation who were enrolled in the years 1993 to 1995. Sixty-one of them were treated by endometrial coagulation and 59 by endometrial resection. All of these women would have undergone hysterectomy had ablation not been an option. Excluded from the study were women younger than 35 years, those whose uterus was more than twice the normal size or had a cavity depth exceeding 12 cm, and those for whom pelvic pain was a major problem.
Only one death, from infection, was related to the initial treatment. Two-thirds of patients had had a single ablation when followed up 2 years after treatment, and the figure after 10 years was 63%. Twenty-six women had had a hysterectomy within 10 years of endometrial ablation. The likelihood of this happening was substantially greater in women less than 40 years of age than in older women (43% vs. 18%). In all, 78% of women had avoided major surgery. The major indications for hysterectomy were bleeding and lower abdominal pain. Only 7% of women still had episodic bleeding 10 years after initial treatment. None of them was more than 45 years of age. On a scale of 0 (“not satisfied”) to 100 (“very satisfied”), the overall degree of satisfaction with the outcome of treatment was 84. Nearly 95% of women would recommend the same treatment.
The investigators believe that endometrial ablation is an excellent way of treating heavy dysfunctional bleeding. In the present series, if a woman required no further intervention within 2 years of ablation, the chance of having a hysterectomy within 10 years after initial treatment was only 6%.
Department of Obstetrics and Gynaecology, Holbaek County Hospital, Holbaek, Denmark
Acta Obstet Gynecol 2007;86:334–338