title: [Does repeated endometrial destruction procedure decrease abnormal uterine bleeding, and does it reduce the number of hysterectomies in this indication?].
abstract: OBJECTIVE
  Hysteroscopic endometrial resection or destruction in the indication of abnormal uterine bleeding or post-menopausal bleeding represents an alternative to hysterectomy, as it carries a lower morbidity rate. In case of failure of such procedure though, hysterectomy will most often be proposed as a second line of treatment. The place of the repetition of an endometrial destruction procedure has not yet been evaluated. The aim of our study is to evaluate the efficiency and the satisfaction after two consecutive techniques of endometrial destruction in case of abnormal uterine bleeding or post-menopausal bleeding.
  
  
  METHODS
  Nineteen patients presenting with recurring abnormal uterine bleeding after one procedure of endometrial destruction, underwent in our department, between 2004 and 2011, a second conservative endometrial procedure.
  
  
  RESULTS
  No complication occurred during the repeated procedure. Sixteen of the nineteen patients (84.2 %) included answered a questionnaire. The mean delay since the second procedure was 27 months [25; 29]. Eight patients (i.e. 50 %) later underwent a hysterectomy, with 5 of them (31.25 % of all 16 patients) being directly attributed to treatment failure. Patients said to be satisfied with the management of their condition in 68.75 % of cases, and 93.75 % of them would recommend it to a friend.
  
  
  CONCLUSIONS
  Our results suggest that a second conservative management in case of recurrence of AUB is effective. Hysterectomy could be avoided in 50 % of cases. A second conservative treatment could be an interesting option for patients with medical contra-indication for heavier surgery, as well as for patients willing to keep their uterus.
authors.affiliation: Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France. Electronic address: yael.levy.zauberman@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Levy-Zauberman
authors.affiliation: Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France. Electronic address: herve.fernandez@bct.aphp.fr.
authors.forename: H
authors.initials: H
authors.lastname: Fernandez
authors.affiliation: Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France. Electronic address: anne.gaelle.pourcelot@bct.aphp.fr.
authors.forename: A-G
authors.initials: AG
authors.lastname: Pourcelot
authors.affiliation: Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France. Electronic address: guillaume.legendre@bct.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Legendre
mesh_terms: D000328:Adult; D004717:Endometrium / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015907:Hysteroscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D017211:Treatment Failure; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*
keywords: Abnormal uterine bleeding; Destruction endométriale; Endometrectomy; Endometrial destruction; Endométrectomie; Hysterectomy; Hysteroscopy; Hystérectomie; Hystéroscopie; Ménométrorragie