Efficacy and satisfaction rate comparing endometrial ablation by rollerball electrocoagulation to uterine balloon thermal ablation in a randomised controlled trial

OBJECTIVE: To compare two methods of endometrial ablation, hysteroscopic rollerball electrocoagulation (RBE) and non-hysteroscopic uterine balloon thermal ablation (Thermachoice trade mark ), regarding efficacy for reducing dysfunctional uterine bleeding and patients satisfaction rate. METHODS: A randomised controlled study was performed in a teaching hospital at the department of gynaecology. One hundred and thirty-seven premenopausal women with dysfunctional uterine bleeding proved by validated menstrual score list were included. Endometrial ablation by a hysteroscopic or non-hysteroscopic method was performed by one gynaecologist. RESULTS: Reduction of menstrual blood loss was significantly more successful at 24 months for thermal ablation with uterine balloon. Success rate measured by menstrual score < 185 for rollerball and thermal balloon ablation are equivalent at 12 and 24 months post-operatively. Satisfaction of the patients for both methods at 24 months post-operatively is not significantly different (respective 75% for rollerball and 80% for uterine balloon). CONCLUSIONS: Endometrial ablation by uterine balloon thermal ablation (Thermachoice trade mark ) is equally effective as hysteroscopic RBE of the endometrium.     

Prediction of successful menorrhagia treatment after thermal balloon endometrial ablation

BACKGROUND: Thermal balloon endometrial ablation (TBEA) is a non-hysteroscopic technique, which relies on a combination of heat and pressure within the uterine cavity to destroy endometrium and superficial myometrium. It is a simple, easy and minimally invasive procedure with an equivalent effectiveness to hysteroscopic endometrial ablation. OBJECTIVES: To evaluate the effectiveness of TBEA in the treatment of menorrhagia and to identify the possible predictive factors for a successful outcome after 2-year follow-up. METHODS: A prospective study was conducted, including 45 patients suffering from serious menorrhagia. Under local anesthesia with i.v. sedation, the Therma-Choice trade mark (Gynecare, Somerville, NJ, USA) balloon was inserted transcervically and after inflation in the endometrial cavity with 5% dextrose, it was heated to 87 degrees C for an 8-minute treatment cycle. RESULTS: There were no intraoperative complications and postoperative morbidity was minimal. At 2-year follow-up the overall improvement of menstrual pattern was 85%; with reported 29% amenorrhea, 23.5% hypomenorrhea and 32.5% euomenorrhea. Menorrhagia persisted in 15% of patients. Multiple logistic regression analysis of the factors that could affect the outcome showed that the chance for a successful treatment increased significantly with increased age (P = 0.044), shorter uterine depth (P = 0.049) and adequate balloon pressure (P = 0.027). These were the predictive factors for successful outcome. However, parity, uterine volume and endometrial thickness were not predictive factors. CONCLUSION: At 2-year follow-up, thermal balloon endometrial ablation is effective in menorrhagia treatment. Increased age, shorter uterine depth and adequate balloon pressure can be predictive factors for successful treatment.     

Three-year comparison of thermal balloon and rollerball ablation in treatment of menorrhagia

STUDY OBJECTIVE: To compare uterine balloon therapy and hysteroscopic rollerball endometrial ablation with respect to efficacy and safety in treatment of menorrhagia. DESIGN: Multicenter, prospective, randomized study (Canadian Task Force classification I). SETTING: Fourteen North American university and private practice sites. PATIENTS: Women undergoing endometrial ablation for menorrhagia. INTERVENTION: Rollerball endometrial ablation or uterine balloon therapy. MEASUREMENTS AND MAIN RESULTS: Of 275 women randomized to one of these procedures, 255 were treated under the protocol and 214 were followed for 3 years. Results of uterine balloon therapy and rollerball endometrial ablation remained similar, with little difference at 3 years compared with results at 1 year. We noted a suggestion of an increase in hysterectomies in the rollerball group (14) compared with the uterine balloon therapy group (8) at 3 years. CONCLUSION: Endometrial ablation with the ThermaChoice uterine balloon or rollerball continues at 3 years to be a successful method for treating menorrhagia, avoiding hysterectomy, decreasing dysmenorrhea and premenstrual symptoms, and improving quality of life. (J Am Assoc Gynecol Laparosc 8(1):48-54, 2001)     

Cost effective management of heavy uterine bleeding: ablative methods versus hysterectomy.

The treatment of menorrhagia in the twentieth century changed after 1960 with the introduction of hormonal therapy as well as an array of laboratory, imaging and minimal access tests for more accurate diagnosis. Since 1981, hysteroscopy has been used for diagnosis as well as the control of thermoablative treatments of bleeding non-malignant endometrium, including laser, electrocoagulation and electroresection. The success rates, complications, intermediate range outcome and cost comparisons with hysterectomy favor hysteroscopic methods. But the long term data on both hysteroscopic ablation and hysterectomy are not yet complete. In an effort to simplify techniques, reduce costs, and reduce complications, a variety of non-hysteroscopic methods and devices have appeared. Only two balloon devices have satisfactory success data as well as sufficient field experience to provide some degree of reliability regarding complications, which appear to be very low. Most of the devices have had clinical trials, which suggest equivalence to hysteroscopic endometrial ablation, but the determination of clinical safety requires at least several thousand cases. However, the levels of effectiveness for most of these devices make them candidates for commercial use. Hysterectomy may move from a primary surgical treatment of menorrhagia to a second-line treatment after ablation, particularly if some of the non-hysteroscopic methods become well accepted. If they are found to be safe, the costs and ease of use for the gynecologist and patient will make them attractive as a first-line surgical option. Hysterectomy, whether abdominal, vaginal, or laparoscopic will then be applied to ablation failures or non-candidates. This has the potential to change gynecological training and practice significantly in the future.     

The impact of endometrial ablation technique at a large university women's hospital

OBJECTIVE: To determine the effect of ThermaChoice uterine balloon system on the practice patterns of endometrial ablations performed at a large university-based teaching hospital. STUDY DESIGN: A retrospective chart review was conducted of 226 patients who underwent endometrial ablation. Data were analyzed to determine any change in the type and rate of ablations performed since the introduction of second-generation technologies. Multivariate logistic regression models were used to estimate adjusted risk factors for subsequent admission. RESULTS: A total of 72.1% of all cases were performed with the ThermaChoice uterine balloon. The postoperative admission rate was significantly higher after a balloon procedure (13.7% versus 3.1%, P=.02), with a 10.6% overall incidence of admission. Adjusting for confounding variables, more women were admitted after a balloon procedure, compared with women undergoing hysteroscopic ablation (odds ratio 5.0; 95% CI: 1.1, 22). CONCLUSION: Second-generation endometrial ablation technologies represent frequently utilized and proficient treatment modalities for dysfunctional uterine bleeding. Notwithstanding their facilitative design, clinicians should not lose sight of potential limitations of these new procedures.     

Endometrial thermal balloon ablation by a simple technique using Foley’s catheter with or without pre ablation endometrial curettage to treat cases with intractable menorrhagia

ObjectivesTo assess the efficacy and safety of endometrial thermal ablation by a technique using Foley’s catheter to treat cases with intractable menorrhagia and to compare between results with and without pre procedure curettage.Study designProspective randomized controlled study.Patients and methodsForty eight patients aged from 39 to 52 years complaining of menorrhagia not responding to treatment for at least 6 months were included in the study, pre ablation endometrial curettage was done for 24 randomly selected cases (group 1) and ablation without curettage for the other 24 cases (group 2). A latex silicon coated Foley’s catheter with 30–50 ml capacity was tested and inserted into uterine cavity then inflated by a variable volume of boiling saline as the uterine cavity permits under moderate pressure and replaced every 2 min with a new boiling saline, for 8 min duration. Then follow up for 6 months and hysteroscopic examination were done to detect endometrial scarring.Outcome measuresPatients satisfaction, menstrual outcome, hysteroscopic diagnosed scarred endometrium.ResultsThis study showed a satisfaction rate of 83.3%, improvement in menstrual bleeding (79.2%) and hysteroscopic diagnosed scarring of the endometrium (75%). Cases in group 1 had a significantly higher satisfaction rate (95.8%) than in group 2 (70.8%) and significantly lower incidence of persistent menorrhagia after ablation than cases in group 2 (4.2% versus 37.5%, respectively). Hysteroscopic diagnosed endometrial scarring was significantly higher in group 1 (91.7%) versus (53.8%) for group 2.ConclusionEndometrial thermal balloon ablation by a technique using Foley’s catheter is a safe, simple, cheap and effective procedure as an alternative to hysterectomy for treatment of menorrhagia in properly selected cases. Pre ablation endometrial curettage increases the satisfaction rate and improves menstrual outcome.     

Hysteroscopic appearance of the endometrial cavity following thermal balloon endometrial ablation

OBJECTIVE: To assess the appearance of the endometrial cavity after thermal balloon endometrial ablation. DESIGN: Observational study. SETTING: University teaching hospital. PATIENT(S): Twenty-two women who had undergone thermal balloon endometrial ablation and who were followed up for at least 6 months. INTERVENTION(S): Outpatient diagnostic hysteroscopy. MAIN OUTCOME MEASURE(S): Appearance of the endometrial cavity and presence of intrauterine adhesions on hysteroscopy. RESULT(S): Postablation intrauterine adhesions were found in eight women (36.4%); six had focal adhesions in the fundal area and two had complete obliteration of the cavity. Of these eight women, three had spotting during menstruation, three had hypomenorrhea, one had eumenorrhea, and one had amenorrhea. The uterine cavity was fibrotic in four (18%) women; all reported spotting during menstruation. Ten women had a normal uterine cavity; eight had hypomenorrhea, one had spotting, and one had eumenorrhea. CONCLUSION(S): The hysteroscopic appearance of the uterine cavity after thermal balloon endometrial ablation varies considerably. Menstrual outcome is associated with postablation appearance.     

Efficacy of thermal balloon ablation in patients with abnormal uterine bleeding

OBJECTIVE: The purpose of this study was to assess changes in menstrual pattern, quality of life, and patient satisfaction after thermal balloon ablation for abnormal uterine bleeding. STUDY DESIGN: One hundred forty-one women who underwent thermal balloon ablation in our institution initially had their charts reviewed for demographics, procedure data, clinical history, and follow-up. Thereafter, a telephone interview was conducted to assess postprocedural menstrual pattern, quality of life, and patient satisfaction. Data were compared with the use of appropriate tests for categoric or continuous variables and logistic regression. RESULTS: The median follow-up time was 18 months, and a telephone interview was obtained for 119 of 141 patients. A reduction in days per cycle (9.6 vs 3.1 days, P<.0001) and in pads per day (12.8 vs 2.5 pads/d, P<.0001) and an improvement in self-reported quality of life scores (2.8 vs 9.0, P<.0001) were observed after thermal balloon ablation. Hysterectomy was required in 21 of 141 patients (15%). Assessment of the level of satisfaction showed that 96% of patients were satisfied or very satisfied with the procedure. No major complications or deaths were related to thermal balloon ablation. CONCLUSION: Thermal balloon ablation is a safe and efficient method to treat abnormal uterine bleeding. It reduces the menstrual flow, improves the quality of life, and remarkably fulfills expectations in selected patients.     

Cavaterm thermal balloon endometrial ablation versus hysteroscopic endometrial resection to treat menorrhagia: the French, multicenter, randomized study

STUDY OBJECTIVE: To compare the efficacy and safety of Cavaterm thermal balloon endometrial ablation with hysteroscopic endometrial resection. DESIGN: Multicenter randomized trial (Canadian Task Force classification I). SETTING: Departments of obstetrics and gynecology in French university hospitals. PATIENTS: Fifty-one women with menorrhagia unresponsive to medical treatment. INTERVENTIONS: Women were randomized to thermal destruction of the endometrium or to hysteroscopic endometrial resection. Women completed preoperative, 6-, and 12-month postoperative pictorial charts to determine Higham blood loss scores and a satisfaction questionnaire. Operative time, discharge time, complication rate, and resumption of normal activities were evaluated for each group. MEASUREMENTS AND MAIN RESULTS: Amenorrhea rates were 36% (95% CI 19%-56%) and 29% (95% CI 8%-51%) in the Cavaterm and the endometrial resection groups at 12 months, respectively (ns). Both treatments significantly reduced uterine bleeding. The median decrease in Higham score at 12 months was significantly higher in women treated by Cavaterm (377, range 108-1300) than in women treated by resection (255, range -82 to 555) (p=.006). A subsequent hysterectomy for recurrent bleeding was performed in 2 women, both previously treated by resection. The rate of women reporting good or excellent satisfaction was 89% (95% CI 72%-98%) in the Cavaterm group and 79% (95% CI 54%-94%) in the resection group at 12 months. Discharge time was significantly lower in women treated by Cavaterm, although postoperative pain at 1 hour was higher. There were no major complications in either group. CONCLUSIONS: Cavaterm thermal balloon ablation was as effective as hysteroscopic endometrial resection to treat menorrhagia, both resulting in a significant reduction in menstrual blood loss and high patient satisfaction.     

The role of Essure sterilization performed simultaneously with endometrial ablation

PURPOSE OF REVIEW: To review operative procedures, specific risks, complications and evaluation of efficacy of Essure tubal sterilization performed simultaneously with endometrial ablation. RECENT FINDINGS: Dysfunctional uterine bleeding is a significant health problem in premenopausal women. Endometrial ablation is an effective therapeutic option for the management of menorrhagia and an alternative to hysterectomy. Most women undergoing endometrial ablation are of reproductive age, and, because pregnancy after endometrial ablation could be complicated, many of these women require permanent birth control. Since the introduction of Essure tubal sterilization, this permanent contraception method has been widely used and offers an hysteroscopic approach similar to endometrial ablation techniques. Combining these two procedures offers the advantage of performing the two procedures simultaneously, but inherent rules and technical procedures must be followed to avoid any kind of injury such as heat conduction, material injuries, specific complications and specific follow-up. SUMMARY: The combination of safety and efficacy of endometrial ablation and hysteroscopic sterilization makes a compelling argument for their concomitant use.     

Hysteroscopic treatment of symptomatic submucous fibroids using a bipolar intrauterine system: a feasibility study

Objective: To determine the feasibility (safety, potential efficacy and cost effectiveness) of a miniature endoscopic bipolar electrosurgical intrauterine system in the treatment of symptomatic submucous fibroids. Study Design: A total of 37 women with symptomatic submucous fibroids were identified on outpatient hysteroscopy. All underwent hysteroscopic excision or ablation using a bipolar intrauterine system (Versapoint™). The main outcomes measures were change in uterine bleeding symptoms measured on a continuous and ordinal scale, patient satisfaction, time of work and use of health service resources at 6 months following treatment. Results: 36/37 (97%) women returned completed outcome questionnaires. The mean amount of abnormal uterine bleeding was reduced at 6 months compared to immediately prior to treatment (P=0.0001). Improvement in bleeding symptoms was reported by 28/36 (78%) women and satisfaction with treatment by 33/36 (92%) women. All procedures were successfully completed, there were no serious operative complications and at 6 months no repeat hysteroscopic procedures were necessary. The mean cost of diagnosis and treatment of submucous fibroids using an endoscopic bipolar intrauterine system was 40% cheaper at 6 months follow-up than a hysterectomy or open myomectomy (£ 1266 versus £ 2123). Conclusion: Hysteroscopic treatment of symptomatic submucous fibroids appears to be safe, efficacious and cost effective. It seems feasible to launch a randomised controlled trial to confirm these provisional results in both the short and longer term.     

Immediate versus delayed treatment of perimenopausal bleeding due to benign causes by balloon thermal ablation

STUDY OBJECTIVE: To compare the effectiveness and safety of thermal balloon ablation without pretreatment with endometrium-thinning agents compared with delayed ablation with pretreatment for women with perimenopausal menorrhagia. DESIGN: Prospective, randomized, controlled trial (Canadian Task Force classification I). SETTING: Hospital-based ambulatory medical center. PATIENTS: Thirty women age 46 to 51 years with severe enough perimenopausal menorrhagia to make them candidates for either hysterectomy or endometrial ablation. Two patients with submucosal myomas and six who had undergone cesarean section were included. INTERVENTIONS: Thirteen patients were randomly assigned to be treated within 30 days and received a single intramuscular administration of gonadotropin releasing hormone (GnRH) analog; 17 women were allocated to be treated within 3 days of enrollment without uterine preparation. A thermal balloon was inserted transcervically under general anesthesia, and after inflation in the endometrial cavity with 5% dextrose in water, was heated to 87 degrees C for 8 minutes. MEASUREMENTS AND MAIN RESULTS: Immediate and long-term major and minor complications and success rates were analyzed. Bleeding patterns and mean duration of menstrual flow were compared between groups at 6-month follow-up. No major intraoperative or postoperative complications occurred in either group, including the women who had recently undergone hysteroscopic myomectomy or had a history of cesarean section. Minor side effects were similar in both groups, and did not exceed 5%. Overall, at 6-month follow-up, 7 women were amenorrheic, 20 hypomenorrheic, and 3 eumenorrheic. No significant differences were noted between women treated with immediate or delayed ablation in either the distribution of bleeding patterns or days of flow per cycle (mean +/- SEM 1.8 +/- 0.42 vs 2.1 +/- 0.75 days, respectively). CONCLUSION: This pilot study suggests that prompt treatment of perimenopausal menorrhagia with thermal balloon endometrial ablation is as effective and safe as deferred therapy combined with GnRH analog as an endometrium-thinning agent. In light of our results, the theory that previous cesarean section and presence of small submucosal myomas constitute relative contraindications for the procedure merits further consideration. (J Am Assoc Gynecol Laparosc 6(2):145-150, 1999)     

Perioperative factors for predicting successful hysteroscopic endometrial ablation

OBJECTIVE: To investigate factors affecting the success of hysteroscopic endometrial ablation in order to improve patient counseling. STUDY DESIGN: Preoperative patient characteristics (age, parity, uterine length, and presence and location of myomas) and intraoperative factors (intracavitary findings, ablation or resection, and operator) were analyzed. Forty-three women with a uterine size of < or = 10 weeks underwent hysteroscopic endometrial ablation or resection and had a median follow-up of 20 months. All were treated with depot triptorelin, 3.75 mg, 1 month prior to the procedure. Alleviation of menorrhagia and amenorrhea was classified as treatment success. Comparative analyses were made between patients with failed vs. successful procedures and with reduced bleeding vs. those with amenorrhea following surgery. RESULTS: Thirty-seven women (86%) reported a decrease in menstrual flow or amenorrhea. In 6 patients (14%), bleeding persisted or became more severe. There were no statistically significant differences between women who had successful vs. failed procedures with regard to all preoperative and intraoperative parameters analyzed. Patients with amenorrhea were significantly older as compared to women with reduced bleeding (47.5 +/- SD 5.0) vs. 44.0 +/- SD 4.1 years, P = .03. CONCLUSION: Most women with uterine size of < or = 10 weeks may expect alleviation of menorrhagia or amenorrhea after surgery. Apart from age, all other preoparative and intraoperative factors examined had no predictive value for a successful procedure. These data are valuable for proper patient counseling before hysteroscopic endometrial ablation.     

Hysteroscopic endometrial ablation as a treatment for abnormal uterine bleeding in patients with renal transplants

STUDY OBJECTIVE: To assess the effectiveness and safety of hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding that develops in patients with renal transplants. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: Yonsei University Medical College, Severance Hospital. PATIENTS: Sixty-two women with abnormal uterine bleeding who had undergone renal transplantation. INTERVENTION: Hysteroscopic endometrial ablation. MEASUREMENTS AND MAIN RESULTS: Fifty-four out of 62 patients (87.0%) who had undergone hysteroscopic endometrial ablation reported decreased bleeding (95% CI: 0.76 to 0.94): amenorrhea in 25 (40.3%), spotting in 19 (30.6%), and eumenorrhea in 10 (16.1%). Mean follow-up duration was 6 months. No complications related to the procedure were reported. Levonorgestrel-releasing intrauterine systems (LNG-IUSs) were inserted into eight patients who experienced continuous bleeding, five of whom showed symptomatic improvement: spotting in three (4.9%) and eumenorrhea in two (3.2%). The three patients (4.9%) in whom the LNG-IUS had no effect had hysterectomies, and the resultant pathologic findings were two cases of adenomyosis and one case of simple endometrial hyperplasia without atypia. CONCLUSION: Hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding that develops in patients with renal transplants is an effective and safe procedure.     

Thermal endometrial ablation: a simple technique

BACKGROUND: To evaluate the effectiveness and safety of a technique for thermal endometrial ablation. METHOD: The study was carried out in three steps; step I on 10 fresh uterine specimens, step II on 14 intact uteri during hysterectomy and step III in five patients, two weeks prior to hysterectomy. A simple device comprising a Foley catheter No. 14F, a three way cannula and a 20 cc syringe was used for the procedure. The balloon of the catheter was inflated within the uterine cavity with boiling normal saline for 9 minutes. Uterine cavity and serosal temperature was recorded during the procedure. Thermal injury was assessed by gross and histological examination of the specimens. RESULTS: The mean maximum endometrial cavity temperature was 91 degrees C whereas serosal temperatures in steps I and II were 34 degrees C and 35.9 degrees C respectively. None of the balloons ruptured in any of the steps and there were no complications. In 13 of 14 specimens in step II, there was a zone of hyperemia with a depth of 3 to 7 mm. The corresponding histological picture was extensive hemorrhage and fragmentation of glands throughout the endometrium including the cornual regions. Consistent findings were noted in step III in which all but one showed extensive coagulative necrosis of the whole of endometrium with edema of the underlying myometrium. There was a statistically significant positive correlation between the volume of fluid injected and depth of hyperemia. CONCLUSION: This technique could be a simple, effective, inexpensive and safe alternative to hysteroscopic endometrial ablation.     

Cavaterm thermal balloon ablation for the treatment of menorrhagia

Fifty patients due to undergo endometrial ablation as a treatment of dysfunctional uterine bleeding were recruited to assess the efficacy and safety of a new thermal balloon ablation system (Cavaterm). The patients were followed up for a mean of 14 months (range 6–24): 34 (68%) have complete amen-orrhoea, 12 (24%) only have spotting, two (4%) are eumenorrhoeic, and two (4%) have had failed treatments. There were no major complications, but two patients have required oral antibiotics for suspected endometritis. Although these preliminary results are encouraging, all patients remain under review to determine long term effect of the procedure. Further evaluation is also underway in the form of a randomised trial against endometrial laser ablation.     

Thermal balloon and rollerball ablation to treat menorrhagia: two-year results of a multicenter, prospective, randomized, clinical trial

STUDY OBJECTIVE: To evaluate 2-year follow-up results in patients participating in a randomized, clinical trial comparing uterine balloon therapy with rollerball endometrial ablation. STUDY DESIGN: Prospective, randomized, clinical trial (Canadian Task Force classification I). SETTING: Fourteen university-affiliated and private practice sites. PATIENTS: Two hundred fifty-five women with menorrhagia. INTERVENTIONS: Patients were randomized to rollerball or uterine balloon endometrial ablation. MEASUREMENTS AND MAIN RESULTS: Patient satisfaction with both treatments was consistently high. Only 15 hysterectomies had been performed (6 for menorrhagia) at the end of 2 years, 11 in the rollerball group, 4 in the balloon therapy group. CONCLUSION: Endometrial ablation by both procedures was highly successful in avoiding hysterectomy and relieving symptoms of menorrhagia. Additional benefits were reduction in dysmenorrhea and premenstrual syndrome.     

Long-term outcome of hysteroscopic endometrial ablation without endometrial preparation

OBJECTIVE: To describe the three-step hysteroscopic endometrial ablation (EA) technique without endometrial preparation, and its long-term outcomes. STUDY DESIGN: Four hundred and thirty-eight premenopausal women with menorrhagia or menometrorrhagia underwent three-step hysteroscopic EA, which consists of rollerball ablation of the fundus and cornual regions, a cutting loop endomyometrial resection of the rest of the cavity, and rollerball redessication of the whole pre-ablated uterine cavity. The main outcome measures were menstrual status, level of satisfaction with the procedure, and the need for repeat ablation or hysterectomy. Questionnaires were completed for 385 women (87.9%) with a mean follow-up of 48.2 months. RESULTS: One hundred and eighty-four responders (47.8%) reported amenorrhea; 177 (46%) had light to normal flow. One patient (0.3%) underwent repeat ablation and 20 (5.2%) underwent hysterectomy: 15 (3.9%) because of endometrial ablation failure and 5 (1.3%) because of indications unrelated to the ablation (three cases of atypical endometrial hyperplasia and two cases of fibroids). Two hundred and ninety-two patients (75.8%) were very satisfied, and 78 (20.3%) satisfied with the results. No major complications occurred and three women (0.8%) became pregnant during the follow-up period. CONCLUSIONS: EA is safe and effective means of treating of menorrhagia and menometrorrhagia in premenopausal women, and helps avoid hysterectomy in 95% of patients suffering from heavy bleeding, with or without uterine fibroids. Women should be informed that the procedure is not contraceptive and that pregnancy is possible after treatment.     

Improving results of hysteroscopic submucosal myomectomy for menorrhagia by concomitant endometrial ablation

STUDY OBJECTIVE: To evaluate the effect of endometrial ablation on the outcome of premenopausal patients undergoing hysteroscopic myomectomy for menorrhagia or menometrorrhagia DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Private practice. PATIENTS: One hundred seventy-seven women with one or more submucosal myomas experiencing menorrhagia or menometrorrhagia. INTERVENTION: Hysteroscopic myomectomy without endometrial ablation in 104 patients and with concomitant endometrial ablation in 73 patients. MEASUREMENTS AND MAIN RESULTS: Bleeding was controlled in 95.9% of patients with endometrial ablation and in 80.8% of patients without endometrial ablation (p = .003). Complete removal of the myoma led to better results (p = .039), which were further improved by endometrial ablation (p = .022). Endometrial ablation improved bleeding in patients whose myomas could not be completely removed, but the difference was not statistically significant (p = .23). Subsequent hysterectomies were not decreased by endometrial ablation (p = .48) or by complete removal of the myoma (p = .83). Hysterectomies for bleeding problems were decreased by endometrial ablation. Pain and dysmenorrhea were a frequent cause of hysterectomy. CONCLUSION: Endometrial ablation at the time of hysteroscopic myomectomy improves results in the control of bleeding.