Immediate versus delayed treatment of perimenopausal bleeding due to benign causes by balloon thermal ablation.
OBJECTIVE
To compare the effectiveness and safety of thermal balloon ablation without pretreatment with endometrium-thinning agents compared with delayed ablation with pretreatment for women with perimenopausal menorrhagia.


METHODS
Prospective, randomized, controlled trial (Canadian Task Force classification I).


METHODS
Hospital-based ambulatory medical center.


METHODS
Thirty women age 46 to 51 years with severe enough perimenopausal menorrhagia to make them candidates for either hysterectomy or endometrial ablation. Two patients with submucosal myomas and six who had undergone cesarean section were included.


METHODS
Thirteen patients were randomly assigned to be treated within 30 days and received a single intramuscular administration of gonadotropin releasing hormone (GnRH) analog; 17 women were allocated to be treated within 3 days of enrollment without uterine preparation. A thermal balloon was inserted transcervically under general anesthesia, and after inflation in the endometrial cavity with 5% dextrose in water, was heated to 87 degrees C for 8 minutes.


RESULTS
Immediate and long-term major and minor complications and success rates were analyzed. Bleeding patterns and mean duration of menstrual flow were compared between groups at 6-month follow-up. No major intraoperative or postoperative complications occurred in either group, including the women who had recently undergone hysteroscopic myomectomy or had a history of cesarean section. Minor side effects were similar in both groups, and did not exceed 5%. Overall, at 6-month follow-up, 7 women were amenorrheic, 20 hypomenorrheic, and 3 eumenorrheic. No significant differences were noted between women treated with immediate or delayed ablation in either the distribution of bleeding patterns or days of flow per cycle (mean +/- SEM 1.8 +/- 0.42 vs 2.1 +/- 0.75 days, respectively).


CONCLUSIONS
This pilot study suggests that prompt treatment of perimenopausal menorrhagia with thermal balloon endometrial ablation is as effective and safe as deferred therapy combined with GnRH analog as an endometrium-thinning agent. In light of our results, the theory that previous cesarean section and presence of small submucosal myomas constitute relative contraindications for the procedure merits further consideration. (J Am Assoc Gynecol Laparosc 6(2):145-150, 1999)
Lissak
A
A
Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center/Technion School of Medicine, 7 Michal Street, Haifa, Israel.
Fruchter
O
O
Mashiach
S
S
Brandes-Klein
O
O
Sharon
A
A
Kogan
O
O
Abramovici
H
H
D017115:Catheter Ablation / Q000379:methods*; D002404:Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007273:Injections, Intramuscular; D008186:Luteolytic Agents / Q000008:administration & dosage; D008595:Menorrhagia / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010865:Pilot Projects; D017697:Premenopause; D011336:Probability; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000008:administration & dosage
D008186:Luteolytic Agents; D017329:Triptorelin Pamoate