Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding.
OBJECTIVE
To evaluate the effectiveness and safety of endometrial laser ablation and transcervical resection of the endometrium compared with hysterectomy in the surgical treatment of women with dysfunctional uterine bleeding.


METHODS
Prospective randomised controlled trial.


METHODS
Gynaecology department of a large teaching hospital.


METHODS
204 women who would otherwise have been undergoing hysterectomy for menorrhagia were recruited between August 1990 and March 1992 and randomly allocated to hysterectomy (n = 99) or conservative (hysteroscopic) surgery (transcervical resection (n = 52) and laser ablation (n = 53)).


METHODS
Operative complications, postoperative recovery, relief of menstrual and other symptoms, patient satisfaction with treatment after six and 12 months.


RESULTS
Women treated by hysteroscopic surgery had less early morbidity and a significantly shorter recovery period than those treated by hysterectomy (median time to full recovery 2-4 weeks v 2-3 months, P < 0.001). Twelve months later 17 women in the hysteroscopy group had had a hysterectomy, 11 for continuing symptoms; 11 women had had a repeat hysteroscopic procedure; 45 were amenorrhoeic or had only a brown discharge; and 35 had light periods. Dysmenorrhoea and premenstrual symptoms improved in most women in both groups. After 12 months 89% (79/89) in the hysterectomy group and 78% (75/96) in the hysteroscopy group were very satisfied with the effect of surgery (P < 0.05); 95% (85/89) and 90% (86/96) thought that there had been an acceptable improvement in symptoms, and 72% (64/89) and 71% (68/96) would recommend the same operation to others.


CONCLUSIONS
Hysteroscopic endometrial ablation was superior to hysterectomy in terms of operative complications and postoperative recovery. Satisfaction after hysterectomy was significantly higher, but between 70% and 90% of the women were satisfied with the outcome of hysteroscopic surgery. Hysteroscopic surgery can be recommended as an alternative to hysterectomy for dysfunctional uterine bleeding.
Pinion
S B
SB
Aberdeen Royal Infirmary.
Parkin
D E
DE
Abramovich
D R
DR
Naji
A
A
Alexander
D A
DA
Russell
I T
IT
Kitchener
H C
HC
D004717:Endometrium / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008599:Menstruation Disturbances / Q000150:complications; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D014592:Uterine Hemorrhage / Q000601:surgery*