Hysteroscopic endometrial ablation is an effective alternative to hysterectomy in women with menorrhagia and large uteri.
OBJECTIVE
To examine the feasibility, safety, and outcome of hysteroscopic endometrial ablation, and to determine the volume of fluid absorbed during resection versus rollerball coagulation in women with menorrhagia and large uteri.


METHODS
Retrospective review (Canadian Task Force classification II-2).


METHODS
University-affiliated teaching hospital.


METHODS
Forty-two consecutive patients (mean +/- SD age 45.6 +/- 6 yrs) with uterine size greater than 12 weeks (cavity >12 cm). Intervention. Endometrial ablation; 26 (62%) women were pretreated to thin the endometrium.


RESULTS
Resection was performed in 27 patients (65%) and rollerball coagulation in 15 (35%). Ablation was successfully performed in all patients in a day surgery setting. Multiple regression analysis examined the relationship of uterine size, pretreatment, procedure, and duration of surgery to amount of glycine absorbed. Glycine absorption was higher with resection than with coagulation (p = 0.04). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.04) but not with duration of the procedure, uterine size, or pretreatment. One patient with uterine fibroids and one with endometrial adenocarcinoma had hysterectomy. With follow-up of 39 (95%) of 41 women (excluding the one with adenocarcinoma) for 14 +/- 2 months, 38 (93%) were very satisfied. Thirty (73%) had amenorrhea, six (15%) had hypomenorrhea (<3 pads/day), and three (7%) had eumenorrhea (<10 pads/day).


CONCLUSIONS
Hysteroscopic endometrial ablation may be a feasible, safe, and effective alternative to hysterectomy in women with menorrhagia and large uteri.
Department of Obstetrics and Gynecology, St. Joseph's Health Center, 268 Grosvenor Street, London, Ontario, Canada.
M A
MA
Eskandar
G A
GA
Vilos
F A
FA
Aletebi
I S
IS
Tummon
D000328:Adult; D004564:Electrocoagulation / Q000379:methods; D004717:Endometrium / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005998:Glycine / Q000627:therapeutic use; D006801:Humans; D015907:Hysteroscopy; D008595:Menorrhagia / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D014599:Uterus / Q000033:anatomy & histology
D005998:Glycine