Endometrial ablation techniques in the treatment of dysfunctional uterine bleeding

Lessard C, Framarin A
Record ID 32003000018
English, French
Authors' objectives:

This assessment report mainly concerns the efficacy, safety and acceptability of microwave endometrial ablation, and compares this technique with transcervical resection of the endometrium, which is the procedure currently performed in Quebec hospitals for dysfunctional uterine bleeding.

Authors' recommendations: Medical treatment is seldom a lasting solution to dysfunctional uterine bleeding and is not without adverse effects. Although it is a type of definitive treatment, hysterectomy not only carries a considerable surgical risk, but also has certain drawbacks and is fairly expensive. In addition, it can cause many psychological and physical changes in women. However, hysterectomy continues to yield a high level of satisfaction, since it guarantees the cessation of bleeding. Endometrial ablation has been proposed because it is a less invasive, more convenient and less expensive procedure when no other gynecologic condition is involved. Women with dysfunctional uterine bleeding prefer endometrial ablation to hysterectomy because this type of treatment enables them to avoid major surgery and because the hospital stay and convalescence are shorter. Various energy sources have been used to destroy the endometrium, and all seem comparable in terms of efficacy and the reoperation rate. Since hysteroscopic endometrial ablation (by laser, rollerball or transcervical resection) and thermal balloon endometrial ablation have accepted status, there would be no particular conditions governing their use. However, because they are innovative techniques, microwave endometrial ablation, hydrothermal endometrial ablation, endometrial cryoablation and impedance-controlled endometrial ablation should be reserved for certain hospitals, which must have the necessary resources and knowledge for systematically gathering and for analyzing all the data arising from their use and for disseminating these data to the medical and scientific communities. Clinical trials with a follow-up of at least three years after the initial ablation would need to be conducted to demonstrate the efficacy of these techniques and to determine the reoperation rate over along period of time. It would be beneficial to examine these techniques further to determine their cost-effectiveness and to confirm their safety when performed by a gynecologist who has not received special training (in the event that the operation is performed in clinics). Lastly, because of its experimental nature, endometrial laser intrauterine thermotherapy (a second-generation technique not assessed in this report) should be the subject of rigorous studies aimed at demonstrating its immediate and late efficacy and safety and at determining its cost-effectiveness and the reoperation rate. Also, the use of this technique should be governed by the conditions that apply to innovative techniques. Technologically, endometrial ablation is evolving at an extremely rapid pace, with large studies of the second-generation techniques presently underway or recently completed. The results of these clinical trials should be published within 12 to 24 months. These rapid changes require instituting a monitoring process and periodically publishing updates, which would enable one to reassess the specific status of each endometrial ablation technique. In conclusion, we often observe a gap between clinical practice and evidence-based evaluative research. The incidence of surgical complications, the ease of use, and personal clinical experience clearly contribute to forming an opinion concerning the clinical utility and efficacy of any treatment. In addition, improvements to and the rapid diffusion of new techniques facilitate their adoption by clinicians, even in the absence of published scientific data.
Authors' methods: Overview
Project Status: Completed
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Menorrhagia
  • Uterine Hemorrhage
  • Endometrium
Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé
Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.