Ten-year follow-up of endometrial ablation

BACKGROUND: This paper presents a ten-year follow-up of a randomized, controlled trial which gives the long-term hysterectomy rate and patient satisfaction rate of transcervical hysteroscopic endometrial ablation in the treatment of heavy dysfunctional bleeding. METHODS: There were 120 women enrolled in the study, from June 10, 1993 to August 31, 1995, all requiring endometrial ablation for the treatment of heavy dysfunctional bleeding. All patients were offered a clinical examination two years postoperatively. Long-term outcome was assessed by completion of a questionnaire five and ten years after initial treatment. Any new symptomatology and need for further treatment or a hysterectomy was registered. A bleeding index and the patients' satisfaction rate and acceptability of the treatment method were stated. RESULTS: Sixty-one patients were treated by endometrial coagulation, and 59 by endometrial resection. No significant difference in the number of hysterectomies or satisfaction rate between the two groups was observed. At a ten-year follow-up, 63% of patients only had one ablation, 11% were treated twice, and 22% had a hysterectomy. Only 3% were lost to follow-up. For the group of patients above 40 years of age, only 17% had a hysterectomy. Since the two-year follow-up only six patients with one hysteroscopic treatment have had further intervention. Ninety-four percent of the women would recommend the treatment to their best female friend. CONCLUSION: The long-term results show that an ablation for heavy dysfunctional bleeding is an excellent treatment. Overall 22% of patients had a hysterectomy. If the patient had no further intervention at the two-year clinical control, there was only a 6% risk of hysterectomy after a period of at least ten years.