Authors' objectives:

This study aims determine the safety, effectiveness, organizational implications and cost-effectiveness of various (nine modalities) second generation endometrial ablation techniques in the management of menorrhagia.

Authors' results and conclusions: Endometrial laser intra-uterine thermotherapy - The clinical data is sparse. Studies have insufficient patient numbers or lengths of follow-up on which to fully evaluate the long-term efficacy, safety or cost effectiveness. Intra-uterine surgery using a coaxial bipolar electrode - The clinical data is insufficient. There are inadequate patient numbers or lengths of follow-up in which to fully evaluate the long-term efficacy, safety or cost effectiveness. Intrauterine instillation of heated saline - Studies on intrauterine instillation of heated saline are prospective, observational studies involving small number of patients and short follow-up. More studies are needed to further address the long term effectiveness. Microwave endometrial ablation - There is some evidence that microwave endometrial ablation is safe and effective. Endometrial cryoablation - There is some evidence that endometrial cryoablation is a safe and effective procedure in the treatment of dysfunctional uterine bleeding. Punctual vaporation - There is evidence that endometrial ablation with a vaporizing electrode is safe and effective. Photodynamic endometrial ablation - Photodynamic endometrial ablation is selective and does not cause endometrial fibrosis or adhesions. There is evidence of effectiveness of photodynamic endometrial ablation. Thermal balloon endometrial ablation - There is sufficient evidence that thermal balloon endometrial ablation is easy to perform and compares favourably with first-generation endometrial ablation, in terms of effectiveness (reduced menstrual bleeding, dysmenorrhoea and premenstrual symptoms with concomitant improvement in quality of life), patient satisfaction and safety profile. It can be undertaken using local anesthesia on an ambulatory basis. Radiofrequency endometrial ablation - There is evidence that radiofrequency endometrial ablation is safe and effective.

Authors' recommendations: Vaporizing electrode, photodynamic endometrial ablation, thermal balloon endometrial ablation and radiofrequency endometrial ablation are recommended for use in endometrial ablation. Further evidence is required before endometrial laser intra-uterine thermotherapy, coaxial bipolar electrode, intrauterine instillation of heated saline, microwave endometrial ablation and endometrial cryoablation can be recommended.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.moh.gov.my/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment Unit

Contact Address: Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia, Level 21, PERKIM Building, Jalan Ipoh, 51200 Kuala Lumpur, Malaysia. Tel: 603 4045 7781, Fax: 603 4045 77 40

Copyright: Malaysian Health Technology Assessment Unit (MHTAU)