Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding.

Abstract

OBJECTIVE:

To evaluate the effectiveness and safety of endometrial laser ablation and transcervical resection of the endometrium compared with hysterectomy in the surgical treatment of women with dysfunctional uterine bleeding.

DESIGN:

Prospective randomised controlled trial.

SETTING:

Gynaecology department of a large teaching hospital.

SUBJECTS:

204 women who would otherwise have been undergoing hysterectomy for menorrhagia were recruited between August 1990 and March 1992 and randomly allocated to hysterectomy (n = 99) or conservative (hysteroscopic) surgery (transcervical resection (n = 52) and laser ablation (n = 53)).

MAIN OUTCOME MEASURES:

Operative complications, postoperative recovery, relief of menstrual and other symptoms, patient satisfaction with treatment after six and 12 months.

RESULTS:

Women treated by hysteroscopic surgery had less early morbidity and a significantly shorter recovery period than those treated by hysterectomy (median time to full recovery 2-4 weeks v 2-3 months, P < 0.001). Twelve months later 17 women in the hysteroscopy group had had a hysterectomy, 11 for continuing symptoms; 11 women had had a repeat hysteroscopic procedure; 45 were amenorrhoeic or had only a brown discharge; and 35 had light periods. Dysmenorrhoea and premenstrual symptoms improved in most women in both groups. After 12 months 89% (79/89) in the hysterectomy group and 78% (75/96) in the hysteroscopy group were very satisfied with the effect of surgery (P < 0.05); 95% (85/89) and 90% (86/96) thought that there had been an acceptable improvement in symptoms, and 72% (64/89) and 71% (68/96) would recommend the same operation to others.

CONCLUSIONS:

Hysteroscopic endometrial ablation was superior to hysterectomy in terms of operative complications and postoperative recovery. Satisfaction after hysterectomy was significantly higher, but between 70% and 90% of the women were satisfied with the outcome of hysteroscopic surgery. Hysteroscopic surgery can be recommended as an alternative to hysterectomy for dysfunctional uterine bleeding.

• Authors: S B Pinion, D E Parkin, D R Abramovich, A Naji, D A Alexander, I T Russell, H C Kitchener
• Journal: BMJ (Clinical research ed.) (BMJ) Vol. 309 Issue 6960 Pg. 979-83 (Oct 15 1994) ISSN: 0959-8138 [Print] England
• PMID: 7772106 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Endometrium (surgery)
• Female
• Humans
• Hysterectomy
• Hysteroscopy
• Laser Therapy (adverse effects, methods)
• Menstruation Disturbances (complications)
• Middle Aged
• Patient Satisfaction
• Prospective Studies
• Uterine Hemorrhage (surgery)