Thermal balloon endometrial ablation therapy induces a rise in uterine blood flow impedance: a randomized prospective color Doppler study.
OBJECTIVE
To evaluate the possible hemodynamic changes in uterine blood flow using transvaginal color Doppler ultrasonography after thermal balloon endometrial ablation therapy.


METHODS
Prospective randomized study.


METHODS
Twenty-seven pre- and post-menopausal women with either menorrhagia or endometrial hyperplasia (no sign of atypia) were randomized to receive either thermal balloon ablation therapy (n = 13) or gestagen therapy (n = 14). In the gestagen therapy group, a 3-month period of medroxy-progesterone acetate (10 mg/day) was given to premenopausal women during cycle days 15-24 and it was given to postmenopausal women continuously. Thermal balloon endometrial ablation therapy was carried out on cycle days 3-8. All the color Doppler measurements were also carried out on cycle days 3-8. Flow waveforms were obtained from the main branch of the uterine arteries, from arcuate arteries and from a subendometrial spiral artery. Doppler flow parameters were used for subsequent statistical analysis. The measurements took place before the initiation of treatment, on the first postoperative day (thermal ablation group only), and 1 month and 6 months after initiation of the study.


RESULTS
No within-group or between-group differences were detected until the time of the last measurement 6 months after initiation of the treatment. Between the two randomized groups, the pulsatility index (PI) was significantly higher in the thermal ablation group in all three arteries in comparison with the gestagen group, in which no change in the PI took place. In the thermal ablation group, a significant rise from the pretreatment level was observed in the PI in the uterine arteries and in the spiral artery 6 months after the therapy.


CONCLUSIONS
Thermal balloon endometrial ablation therapy induces a rise in uterine blood flow impedance, but not until 6 months after the treatment. The rise in impedance may be due to fibrosis in the uterine cavity which thermal balloon therapy has been shown to produce.
Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland. ijarvela@cc.oulu.fi
I
I
Järvelä
A
A
Tekay
M
M
Santala
P
P
Jouppila
D017115:Catheter Ablation; D002404:Catheterization; D004714:Endometrial Hyperplasia / Q000601:surgery*; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D008595:Menorrhagia / Q000601:surgery*; D017698:Postmenopause; D017697:Premenopause; D045167:Progesterone Congeners / Q000627:therapeutic use; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging
D045167:Progesterone Congeners; D017258:Medroxyprogesterone Acetate