title: Long-term outcome of hysteroscopic endometrial ablation without endometrial preparation.
abstract: OBJECTIVE
  To describe the three-step hysteroscopic endometrial ablation (EA) technique without endometrial preparation, and its long-term outcomes.
  
  
  METHODS
  Four hundred and thirty-eight premenopausal women with menorrhagia or menometrorrhagia underwent three-step hysteroscopic EA, which consists of rollerball ablation of the fundus and cornual regions, a cutting loop endomyometrial resection of the rest of the cavity, and rollerball redessication of the whole pre-ablated uterine cavity. The main outcome measures were menstrual status, level of satisfaction with the procedure, and the need for repeat ablation or hysterectomy. Questionnaires were completed for 385 women (87.9%) with a mean follow-up of 48.2 months.
  
  
  RESULTS
  One hundred and eighty-four responders (47.8%) reported amenorrhea; 177 (46%) had light to normal flow. One patient (0.3%) underwent repeat ablation and 20 (5.2%) underwent hysterectomy: 15 (3.9%) because of endometrial ablation failure and 5 (1.3%) because of indications unrelated to the ablation (three cases of atypical endometrial hyperplasia and two cases of fibroids). Two hundred and ninety-two patients (75.8%) were very satisfied, and 78 (20.3%) satisfied with the results. No major complications occurred and three women (0.8%) became pregnant during the follow-up period.
  
  
  CONCLUSIONS
  EA is safe and effective means of treating of menorrhagia and menometrorrhagia in premenopausal women, and helps avoid hysterectomy in 95% of patients suffering from heavy bleeding, with or without uterine fibroids. Women should be informed that the procedure is not contraceptive and that pregnancy is possible after treatment.
authors.affiliation: Department of Obstetrics and Gynecology, San Camillo Hospital, Trento, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rosati
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vigone
authors.forename: Francesco
authors.initials: F
authors.lastname: Capobianco
authors.forename: Daniela
authors.initials: D
authors.lastname: Surico
authors.forename: Elena
authors.initials: E
authors.lastname: Amoruso
authors.forename: Nicola
authors.initials: N
authors.lastname: Surico
mesh_terms: D000328:Adult; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy / Q000379:methods*; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology