Long-term Outcome of Hysteroscopic Endometrial Ablation in the Treatment of Dysfunctional Uterine Bleeding

Abstract

Objectives: To evaluate the long-term outcomes of hysteroscopic endometrial ablation in the treatment of dysfunctional uterine bleeding in a regional hospital in Hong Kong.
Design: This was a retrospective cohort review and telephone survey of 134 patients who had heavy dysfunctional uterine bleeding unresponsive to medical treatment. They underwent hysteroscopic endometrial ablation between 1998 and 2005. Primary outcomes included: treatment success in terms of reduction in menstrual flow, need of second operation, and patient satisfaction. Secondary outcomes included: short- and long-term complications and factors associated with successful outcomes.
Results: A total of 134 hysteroscopic endometrial ablations were performed during the study period. Concurrent hysteroscopic myomectomy and polypectomy were performed for 46 (34%) and 15 (11%) of the patients, respectively. The median operating time was 30 minutes, and median blood loss was 10 ml; 93% of the patients were discharged within 24 hours. Majority (96%) of the operations were deemed successful, as the patients developed either amenorrhoea or hypomenorrhoea. Five patients failed endometrial ablation, three of whom had a subsequent hysterectomy. Preoperative endometrial preparation and uterine size correlated with treatment success. Short-term complications included over-absorption of the distending medium and endometritis (in 5% and 4% of the patients, respectively). Cyclical pelvic pain (10%) with or without haematometra or haematosalpinx were observed as long-term complications. Overall 92% of patients were satisfied with their operative results.
Conclusion: Hysteroscopic endometrial ablation is a safe and effective surgical option for dysfunctional uterine bleeding. It allows concurrent surgical resection of submucosal fibroids and endometrial polyps, which are commonly associated with heavy menstrual flow. Its advantages are short hospital stays and early recovery, and most women find it a satisfactory solution for their menstrual problems.