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Endometrial Resection for Menorrhagia

New techniques for hysteroscopic ablation of the endometrium have recently begun to allow some women with menorrhagia to avoid hysterectomy. But how effective is endometrial resection, and how often is additional surgery required?

In this prospective observational study, 525 consecutive women with severe, symptomatic menorrhagia were treated with endometrial resection at a single institution and were followed by yearly questionnaires for up to five years. The complication rate was 6% from the initial procedure, and no women required emergency hysterectomy. During follow-up, 16% of women required further gynecologic surgery, and 9% ultimately required hysterectomy. By year five, virtually all women who returned questionnaires reported improvement in menstrual bleeding, and 26% to 40% reported amenorrhea in any given year. Menstrual pain was either eliminated or lessened in 71% to 80%. Age over 45 and a diagnosis of dysfunctional uterine bleeding predicted treatment success of the initial resection.

Comment: Endometrial resection appears to be an effective alternative to hysterectomy. But an editorial sounds a cautionary note: because this technique is effective and relatively inexpensive, there is a danger that it will be used inappropriately for women who could be treated medically. As with any new technology, careful studies are needed to create guidelines for its use.

— SD Gharib

Published in Journal Watch Women's Health August 1, 1996

Source

O'Connor H; Magos A. Endometrial resection for the treatment of menorrhagia. N Engl J Med 1996 Jul 18 335 151-156.

Carlson KJ; Schiff I. Alternatives to hysterectomy for menorrhagia. N Engl J Med 1996 Jul 18 335 198-199.