Endometrial ablation; less is more? Historical cohort study comparing long-term outcomes from two time periods and two treatment modalities for 854 women.

Abstract

BACKGROUND:

Abnormal uterine bleeding needs surgical treatment if medical therapy fails. After introduction of non-hysteroscopic endometrial ablation as alternative to hysteroscopic endometrial resection, we aimed to compare short and long-term outcomes for women treated with these two minimally-invasive procedures. A secondary goal was comparing the present cohort to a previous cohort of women treated with hysteroscopic resection only.

MATERIALS AND METHODS:

Historical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during 2006-2014. Similar patient file and patient-reported outcome data were collected from 386 hysteroscopic resections in a previous cohort (1992-1998). Categorical variables were compared by Chi-square or Fisher´s Exact-test, linear variables by Mann-Whitney U-test and time to hysterectomy by the Kaplan-Meier method.

RESULTS:

During 2006-2014, 772 women were treated with endometrial resection or ablation, 468 women (61%) consented to study-inclusion; 333 women (71%) were treated with hysteroscopic resection and 135 (29%) with endometrial ablation. Preoperative characteristics were significantly different for women treated with hysteroscopic resection compared to endometrial ablation in the 2006-2014-cohort and between the two time-cohorts regarding menopausal, sterilization and myoma status (p≤0.036). The endometrial ablation group had significantly shorter operation time, median 13 minutes (95% Confidence Interval (CI) 12-14) and a lower complication rate (2%) versus operation time, median 25 minutes (95% CI 23-26) and complication rate (13%) in the hysteroscopy group, all p ≤0.001. The patient-reported rate of satisfaction with treatment was equivalent in both groups (85%, p = 0.955). The endometrial ablation group had lower hysterectomy rate (8% vs 16%, p = 0.024). Patient-reported satisfaction rate was higher (85%) in the 2006-2014-cohort compared with the 1992-1998-cohort (73%), p<0.001.

CONCLUSIONS:

Endometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding.

• Authors: Liva Helleland, Lena Flekke Bergesen, Karen Jakobsen Rinnan, Ingeborg Bøe Engelsen, Knut Hordnes, Jone Trovik
• Journal: PloS one (PLoS One) Vol. 14 Issue 7 Pg. e0219294 ( 2019) ISSN: 1932-6203 [Electronic] United States
• PMID: 31291298 (Publication Type: Journal Article)

Topics

• Adult
• Cohort Studies
• Endometrial Ablation Techniques
• Endometrium (physiopathology, surgery)
• Female
• Humans
• Hysteroscopy
• Metrorrhagia (physiopathology, surgery)
• Middle Aged
• Operative Time
• Patient Satisfaction
• Pregnancy
• Treatment Outcome