Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects

Alexander, David; Naji, Audrey; Pinion, Sheena B.; Mollison, Jill; Kitchener, Henry C; Parkin, David E.; Abramovich, D. R.; Russell, Ian

doi:10.1136/bmj.312.7026.280

Cited by 125 publications

(89 citation statements)

References 25 publications

(23 reference statements)

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“…the probability of cancer or cancer development in the remaining glands) of endometrial ablative techniques, while previously published studies on hysterectomy report better clinical outcomes in terms of patient satisfaction in the medium/long term [1,13,[25][26][27].…”

Section: Discussionmentioning

confidence: 60%

“…In light of the above-mentioned facts, minimally invasive hysteroscopic surgery has been considered a relatively safe, effective alternative to hysterectomy in short-term follow-up studies [1,2,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Inconsistent results regarding complication and success rates at different follow-up periods are also easily to be found in the literature [1,2,7,24].…”

Section: Discussionmentioning

confidence: 95%

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Thermal Balloon Ablation in Myoma-Induced Menorrhagia under Local Anesthesia

Soysal

Vıcdan

2001

Gynecol Obstet Invest

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Objective: Our purposes were to compare the impact of surgery on menstrual blood flow reduction and on the increase in hemoglobin values as primary endpoints at 12 months, and operating time, complication rates, postoperative pain scores at 12 h and surgically induced amenorrhea rates at 12 months as secondary endpoints after roller ball endometrial ablation or thermal balloon ablation for myoma-induced menorrhagia. Materials and Methods: Menorrhagic women (documented by a validated pad scoring system) over 40 years of age, with a mobile myomatous uterus smaller than 12-week pregnancy, were enrolled in a prospective randomized trial to compare endometrial roller ball ablation and thermal balloon ablation after pharmacological endometrial thinning. One year after surgery, primary and secondary endpoints in both groups were compared. Results: Forty-five subjects underwent endometrial thermal balloon ablation under local anesthesia and 48 underwent endometrial roller ball ablation under general anesthesia. Statistically significant but similar decreases in mean pictorial blood assessment score and increases in mean hemoglobin values were noted for both groups at 12 months. Those who underwent endometrial roller ball ablation had experienced significantly more intraoperative complications. Conclusion: Thermal balloon ablation under local anesthesia for myoma-induced menor- rhagia provided both significant and statistically similar reductions in menstrual blood flow and increases in hemoglobin values with no intraoperative complication compared to roller ball endometrial ablation.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 95%

Thermal Balloon Ablation in Myoma-Induced Menorrhagia under Local Anesthesia

Soysal

Vıcdan

2001

Gynecol Obstet Invest

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“…Some studies suggest that psychological factors may play a role in the perception of menorrhagia. Women who have a hysterectomy for menorrhagia are more often depressed 5,23,24 and less likely to show signi®cant gynaecological pathology 25,26 than women who have a hysterectomy for other causes. Psychological problems are more common in women seeking care for menorrhagia compared with other gynaecological problems 7 .…”

Section: Discussionmentioning

confidence: 99%

Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss

Hurskainen

Aalto

Teperi

et al. 2001

BJOG

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Objective To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia. Design Cross-sectional comparative study of women referred for menorrhagia.Setting Gynaecology departments of all ®ve university teaching hospitals in Finland.Sample Two hundred and twenty-six women aged 35-49 years complaining of menorrhagia. Main outcome measures Several psychosocial factors, seeking medical attention, menstrual blood loss.Results Twenty-nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss ,60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained signi®-cant variables by multivariate analysis.Conclusions A signi®cant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia.

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“…However, the patients who decided to have surgical treatment had suffered from symptoms of menorrhagia and associated anemia chronically, and in many cases, had been frustrated with the ineffective medical interventions. Moreover, patients waiting for gynecologic surgery have high levels of psychiatric disorders, including anxiety and depression [22, 23]. Based on this clinical situation, we reasoned that long-term preoperative treatment for iron replacement would have little clinical benefit.…”

Section: Discussionmentioning

confidence: 99%

Safety and Usefulness of Intravenous Iron Sucrose in the Management of Preoperative Anemia in Patients with Menorrhagia: A Phase IV, Open-Label, Prospective, Randomized Study

et al. 2009

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Background: The aim of this study was to compare the efficacy, safety and achievement of the target hemoglobin level (Hb ≥10 g/dl) in patients with preoperative anemia due to menorrhagia who received intravenous iron sucrose compared with oral iron protein succinylate for anemia management. Methods: Seventy-six patients with Hb levels <9.0 g/dl who were scheduled to undergo surgical treatment were randomized to receive either intravenous iron sucrose (based on the calculated total iron deficit divided into 2 ampoule infusions intravenously 3 times a week, beginning 3 weeks before surgery) or oral iron (80 mg/day of oral iron protein succinylate daily). Results: The intravenous iron group had higher increases in Hb (3.0 vs. 0.8 g/dl; p < 0.0001) and ferritin levels (170.1 vs. 4.1 μg/l; p < 0.0001) than the oral iron group. Achieving the target Hb was also higher in the intravenous iron group than in the oral iron group (76.7 vs. 11.5%; p < 0.0001). There were tolerable adverse events in both groups. Conclusion: Preoperative intravenous iron sucrose administration is more effective than oral iron and is as safe as oral iron therapy in the correction of preoperative anemia due to menorrhagia.

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Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects

Abstract: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness.

Cited by 125 publications

References 25 publications

Thermal Balloon Ablation in Myoma-Induced Menorrhagia under Local Anesthesia

Thermal Balloon Ablation in Myoma-Induced Menorrhagia under Local Anesthesia

Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss

Safety and Usefulness of Intravenous Iron Sucrose in the Management of Preoperative Anemia in Patients with Menorrhagia: A Phase IV, Open-Label, Prospective, Randomized Study

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