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Abnormal Uterine Bleeding: The Drastic Measure Isn’t the Only Solution

Endometrial ablation was effective and was associated with fewer complications than hysterectomy.

Is hysterectomy — one of the most common surgeries among U.S. reproductive-age women — the best approach for managing dysfunctional uterine bleeding? In a randomized, controlled trial sponsored by the Agency for Healthcare Research and Quality, women with excessive or irregular uterine bleeding refractory to medical therapy were assigned to hysterectomy or endometrial ablation (EA). The primary outcome was effectiveness in resolving the foremost problem (typically, excessive bleeding) that led them to seek care. Eligible women did not wish to retain their fertility. Hysterectomy was performed vaginally, laparoscopically, or abdominally. EA was done by resectoscope or thermal balloon.

At 2 years of follow-up, EA had resolved the problem necessitating care in almost 85% of patients (90/106), whereas hysterectomy had resolved the problem in 94% (101/107). Almost one third of women who underwent EA required reoperation for bleeding-related complaints within 4 years. However, adverse events such as thromboembolic and cardiorespiratory events and readmission for surgery were four times more common in the hysterectomy group than in the EA group; postoperative infection was almost six times more common after hysterectomy.

Comment: Guiding patients through treatment decisions for uterine problems can be challenging, especially because many studies are not randomized and controlled and have somewhat cloudy endpoints. The results of this study provide women and their healthcare providers with a basis for comparing the outcomes of EA, a less-invasive and less-morbid procedure, to those of hysterectomy. The findings clearly show that EA is successful for most patients; however, some who remain unsatisfied will go on to choose hysterectomy. The complication rate of hysterectomy and the lost time from normal activity should be acknowledged in counseling. Too often I have heard patients and even clinicians say, "Why not get this problem taken care of forever?" Nevertheless, EA should be strongly considered because it is quite successful and has a relatively low complication rate.

— Ann J. Davis, MD

Published in Journal Watch Women's Health February 7, 2008

Citation(s):

Dickersin K et al. and the STOP-DUB Research Group. Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: A randomized controlled trial. Obstet Gynecol 2007 Dec; 110:1279.

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