Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: a randomized controlled trial.
OBJECTIVE
To compare the effectiveness of hysterectomy and endometrial ablation in women with dysfunctional uterine bleeding.


METHODS
The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding was a multicenter, randomized controlled trial. Eligible women were premenopausal with dysfunctional uterine bleeding and aged 18 years or older. Primary outcomes were problems that led the woman to seek care solved, bleeding, pain, and fatigue at 12 months. Additional outcomes included quality of life, adverse events, reoperation, and others at 24 months and up to 5 years.


RESULTS
We randomly assigned 237 women between January 1998 and June 2001. Follow-up ended in June 2003. We completed 24 months of follow-up on 114 of 123 women assigned to endometrial ablation and 111 of 114 assigned to hysterectomy. Approximately 85% of women were aged younger than 45 years; 76.4% classified themselves as white, 18.6% as African American, less than 1% as Asian, 4.6% as American Indian, and 8.4% as Hispanic (classification within more than one category possible). Both endometrial ablation and hysterectomy were effective at 24 months in solving the problem that led women to seek care (84.9% compared with 94.4%), and in relieving bleeding, pain, fatigue, and other symptoms, although hysterectomy was more effective for bleeding. By 48 months, 32 of the 110 women initially receiving endometrial ablation required reoperation. Adverse events were more frequent with hysterectomy.


CONCLUSIONS
Both endometrial ablation and hysterectomy are effective treatments in women with dysfunctional uterine bleeding. Hysterectomy (as the index surgery) was associated with more adverse events and a substantial number of patients receiving endometrial ablation had reoperation.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00114088


METHODS
I.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. kdickers@jhsph.edu
Kay
K
Dickersin
Malcolm G
MG
Munro
Melissa
M
Clark
Patricia
P
Langenberg
Roberta
R
Scherer
Kevin
K
Frick
Qi
Q
Zhu
Linda
L
Hallock
John
J
Nichols
Tamer M
TM
Yalcinkaya
D000328:Adult; D002170:Canada; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D008796:Metrorrhagia / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D014481:United States