First-generation endometrial ablation revisited: retrospective outcome study—a series of 218 patients with premenopausal dysfunctional bleeding

Abstract

Premenopausal dysfunctional bleeding (PDB) is a common medical problem. Surgery is typically performed after the failure of a medical approach. Surgical options include endometrial ablation techniques or a hysterectomy. The aims of our study are to measure the outcome parameters of firstgeneration endometrial ablations (fgEA) and to identify patient-related prognostic factors. We included all fgEAs performed between September 2001 and December 2011 at the General Hospital of Turnhout, Belgium (n=218). The outcome was defined by the need for a postoperative therapy (group 1-no therapy; group 2-therapy, but no hysterectomy; group 3-hysterectomy). We also rated postoperative amenorrhea and patient satisfaction. The prognostic factors examined were associated dysmenorrhea, a history of cesarean section, preoperative duration of blood loss, age, parity, and a history of tubal ligation sterilization. We used Excel 2011, Version 14.0.0, and Statplus Mac LE 2009 for our statistical analysis. The hysterectomy rate post-fgEA was 10 % (22/ 218). The rate of amenorrhea (defined as cessation of bleeding from 3 months postprocedure until the moment the patient was interviewed) was 76 % (165/218). Ninety-two percent (202/218) of patients were either satisfied or very satisfied with the procedure and outcome. The only significant prognostic factor was the age of the patient at the time of the fgEA (p=0.0004 for mean age at time of fgEA and p=0.0433 for comparison pre-versus perimenopausal age). The outcome of this fgEA technique is often underestimated and can still result in a high amenorrhea and satisfaction rate and low postoperative hysterectomy rate.