Authors' objectives:

This report aims to assess the effectiveness of surgical alternatives to hysterectomy for abnormal uterine bleeding.

Authors' recommendations: For carefully selected patients with symptomatic, objectively confirmed menorrhagia and uterine size <12 week's gestation (or 10 to 12 cm in length), endometrial ablation by TCRE, endometrial laser ablation (ELA), or thermal balloon ablation of the endometrium (TBEA) is a safe alternative to hysterectomy. Endometrial ablation does not always result in amenorrhea, results may be limited simply to a reduction in the amount of menstrual blood loss each month. Patients undergoing endometrial ablation should be completed with childbearing. However, since the possibility of pregnancy remains after endometrial ablation, sexually active women of reproductive age should make every effort to prevent pregnancy. Endometrial ablation is associated with a low rate of complications and few major complications. It is possible, that after endometrial ablation, there may be difficulty in diagnosing endometrial cancer if it occurs in residual tissue. The effects of estrogen replacement therapy in postmenopausal women on residual endometrium are unknown. Presently, there is no objective, standardized measurement of menorrhagia, making comparison of treatments for abnormal uterine bleeding difficult. Total direct and indirect costs of endometrial ablation are significantly lower than those for hysterectomy. However, if future re-treatment or additional procedures are needed, the difference in cost between endometrial ablation and hysterectomy diminishes. The medical community should establish guidelines to objectively measure menorrhagia. Additional data from well-designed, randomized controlled trials comparing the different techniques of endometrial ablation with drug therapies, hysterectomy, and each other should be undertaken to determine the most effective, safest, and least costly alternative to hysterectomy. Physicians should discuss risks and benefits of all options, including endometrial ablation techniques and hysterectomy, with each patient in order to choose the procedure which will best suit each individual patient's needs. Because the uterus is still in place following endometrial ablation, the possibility of endometrial cancer still exists. There is also a concern that the diagnostic evaluation for endometrial cancer in women who have undergone endometrial ablation may be more difficult. Therefore, all women presenting with suspicious symptoms should be evaluated.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.health.state.mn.us/htac/sah.htm

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Health Technology Advisory Committee

Contact Address: Queries should be referred to the Minnesota Department of Health (http://www.health.state.mn.us/)

Copyright: Health Technology Advisory Committee