Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding

Lethaby, Anne; Shepperd, Sasha; Farquhar, Cindy; Cooke, Inez

doi:10.1002/14651858.cd000329

Cited by 114 publications

(139 citation statements)

References 53 publications

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“…It is a major operation, performed either by laparotomy, laparoscopy, or vaginally [74], with associated morbidity and even mortality that requires hospitalization for a few days and several weeks for full recovery. TCRE or ablation is an effective and possibly cheaper alternative to hysterectomy with faster recovery although re-treatment is sometimes needed [75]. The CREST study on the complication rate for minor and major operations, reports a 25% complication rate for vaginal hysterectomy and a 43% for abdominal hysterectomy [76].…”

Section: Hysterectomysupporting

confidence: 91%

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Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

et al. 2011

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Abnormal uterine bleeding is one of the most common problems in women of reproductive age, and dysfunctional uterine bleeding (DUB) accounts for about half the cases. The aim of this review is to present all treatment options for women suffering from DUB and to evaluate their effectiveness. A detailed search strategy on electronic databases was carried out to identify trials and reviews on management of abnormal uterine bleeding. Tranexamic acid is the most effective medical treatment. A levonorgestrel-releasing intrauterine device is a low-cost, simple, and effective medical method, comparable to hysterectomy in terms of quality of life. In cases of DUB resistant to medical treatment, surgical treatment should be offered. First-generation ablation techniques are effective, but have a long learning curve. Second-generation ablation devices are highly effective and safe alternatives, thoroughly compared to first-generation techniques. Hysterectomy is the only method that guarantees treatment of dysfunctional uterine bleeding, but is a major operation associated with higher morbidity and mortality rates. Proper counseling of each woman with DUB regarding all treatment modalities can provide the best choice for each patient. More prospective randomized trials are needed to establish the effectiveness of these methods

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Section: Hysterectomysupporting

confidence: 91%

“…These complication rates are significantly higher than those of firstgeneration endometrial ablation techniques. Despite this fact, the satisfaction rate remains higher in women treated with hysterectomy, so does quality of life [75].…”

Section: Hysterectomymentioning

confidence: 99%

Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

et al. 2011

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“…In this study, the high rate of amenorrhea with the Novasure system is consistent with previous studies compared to the Thermablate group [4,[7][8][9]. Although if we stated that the combined symptoms of amenorrhea and a lighter menstrual period concluded a satisfied patient, the two groups had comparable rate.…”

Section: Discussionmentioning

confidence: 99%

“…Although if we stated that the combined symptoms of amenorrhea and a lighter menstrual period concluded a satisfied patient, the two groups had comparable rate. In most studies, amenorrhea is considered a successful primary outcome but another important outcome to consider is the subsequent re-intervention rate [7,8]. This has implications on women's morbidity and mortality who require further intervention to control their symptoms.…”

Section: Discussionmentioning

confidence: 99%

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An Observational Study on the Long Term Follow-up Following Thermablate and NovaSure Endometrial Ablations

Chen¹,

Mohamed²,

Qaiser³

et al. 2017

OGIJ

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Objectives: A 5-year observation study investigated the quality of life and intervention rates following the Thermablate thermal balloon endometrial ablation (Thermablate EA) and the NovaSure radiofrequency impedance-based ablation (Novasure).Methods: Anonymous information for the study was gathered from 'NOTIS', the electronic system used within our Trust to hold patient data. Following the ablation subsequent procedures that occurred were listed as well as the bleeding pattern recorded.Results: There were 123 women treated with the Novasure system and 168 women with Thermablate EA. A greater number of women treated with the Novasure system became amenorrheic (64%) compared to the Thermablate EA group (24%). However more women who were treated with the Novasure system compared to the Thermablate EA suffered post ablation pain, (13.8% and 1.8%) and remained unsatisfied. In the Novasure group, 67.8 % had no subsequent interventions as compared to 75.6 % in the Thermablate EA group (p=.001). In the Thermablate EA group, 7% had subsequent medical treatment compared to 12% of the NEA women. There are more women opted for hysterectomy in the Novasure group (20.3%) as compared to 8.3% in the Thermablate EA. The odds ratio of women having hysterectomy after the Novasure as compared to Thermablate EAS group is 2.8 (95% CI = 1.37 -5.71). Conclusion:Women may prefer the Thermablate EA with the associated less medical intervention and hysterectomy rates despite more women becoming amenorrheic after a Novasure treatment. This has implications on cost and patient satisfaction when deciding on initial treatment.

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