Endometrial ablation for postmenopausal uterine bleeding induced by hormone replacement therapy.
OBJECTIVE
To determine the effectiveness of transcervical endometrial ablation or endomyometrial resection for treating refractory postmenopausal uterine bleeding induced by hormone replacement therapy (HRT).


METHODS
Prospective observational study.


METHODS
Community, teaching, and proprietary hospitals.


METHODS
Twenty-nine postmenopausal women experiencing troublesome uterine bleeding while taking hormones.


METHODS
Hormone manipulation, office hysteroscopy or sonohysterography, endometrial curettage, and transcervical endometrial ablation or endomyometrial resection were performed in all 29 patients.


RESULTS
Twenty-seven women (93.1%) who continued HRT became amenorrheic within 2 months of surgery. The two who did not have irregular, intermittent spotting, but neither one required or desired further surgical intervention. Five women discontinued HRT from 3 to 53 months postoperatively (mean 12.5 +/- 8.2 mo) because of apprehension about developing breast cancer and for personal reasons. The 24 (82.8%) who continued HRT were observed for as long as 99 months (mean 36.4 +/- 5.5 mo); 22 (91.6%) of them remained amenorrheic. Pathologic examination of tissue specimens revealed atrophic endometrium in 4 patients, adenomyosis in 7, simple hyperplasia in 4, submucous leiomyomas in 11, endometrial polyps in 4, and proliferative endometrium in 1. There were no perioperative complications.


CONCLUSIONS
Endometrial ablation or endomyometrial resection was an effective alternative to discontinuing HRT for these postmenopausal women whose uterine bleeding was unrelieved by modification of their sex steroid regimens.
Phillips
D R
DR
Department of Obstetrics and Gynecology, South Nassau Communities Hospital, Oceanside, New York, USA.
D000368:Aged; D000556:Ambulatory Surgical Procedures; D001284:Atrophy; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000209:etiology; D003475:Curettage; D004714:Endometrial Hyperplasia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004715:Endometriosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011127:Polyps / Q000209:etiology / Q000473:pathology / Q000601:surgery; D017698:Postmenopause; D011446:Prospective Studies; D016312:Treatment Refusal; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014594:Uterine Neoplasms / Q000209:etiology / Q000473:pathology / Q000601:surgery