Menorrhagia is a serious health problem for premenopausal women; pathology can reduce the quality of life and can lead to social impairment and physical problems such as iron deficiency anemia.
First-line treatment has traditionally consisted of medical therapy (hormonal and non-hormonal), but this has not always been successful in reducing menstrual bleeding to an acceptable level. Hysterectomy is a radical method, but it is more expensive and carries some risks.
Endometrial ablation may be an alternative to hysterectomy that preserves the uterus. Many methods have been developed to "remove" mucous membrane of the endometrium. First generation methods require visualization of the endometrium with a hysteroscope during the procedure; although it is safe, this procedure requires certain technical skills. Newer endometrial ablation techniques (second and third generation) have been developed that do not require hysteroscopic imaging during the procedure.
In the article estet-portal.com you can read in detail the results of a Cochrane review of randomized trials regarding the efficacy, safety and acceptability of endometrial disruption methods for the treatment of menorrhagia.
Menorrhagia: research into endometrial ablation techniques
Randomized controlled trials comparing different methods of endometrial ablation or resection in women reporting menorrhagia without uterine pathology (excluding extrauterine fibroids and fibroids smaller than 3 cm) were acceptable.
Menorrhagia (abundant menstruation) — blood loss during menstruation, exceeding the physiological norm (~150 ml).
Authors included 28 studies (4287 women) with sample sizes ranging from 20 to 372. A general comparison of second generation and first generation methods (i.e. hysteroscopic ablative method) found no difference in amenorrhea at 1 year and at 2-5 years, and there was no difference in subjective improvement scores after 1 year of follow-up.
Study results showed no difference in patient satisfaction after second and first generation techniques at 1 year follow-up (11 studies; 1750 women; low-quality evidence) and at 2-5 years of follow-up (672 women; 4 studies).
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Compared to first-generation methods, second-generation endometrial ablation methods were associated with shorter operative time (mean difference (MD) - 13.52 minutes, 95% CI - 16.90 - 10.13; 9 studies; 1822 women; low-quality evidence) and were performed more frequently under local rather than general anesthesia (6 studies; 1434 women; low-quality evidence).
Authors are unsure if perforation rates differed between second and first generation techniques (1885 women; 8 studies).
Studies reported little or no difference between second and first generation methods in the need for additional surgery (ablation or hysterectomy) at 1 year follow-up (6 studies: 935 women; low-quality evidence).
After 5 years, results have shown that there is probably little or no difference between groups in the indication for hysterectomy (4 studies; 758 women; moderate-quality evidence).
Diagnosis and treatment of dysfunctional uterine bleeding
Evolution of Approaches to Endometrial Ablation
Approaches to endometrial ablation have evolved from first generation methods to newer second and third generation approaches.
Current evidence suggests that, compared with first generation methods (laser endometrial ablation, transcervical endometrial resection, roller endometrial ablation), second generation approaches (thermal balloon endometrial ablation, microwave endometrial ablation, hydrothermal ablation, bipolar radiofrequency endometrial ablation, endometrial cryotherapy) have equivalent efficacy in heavy menstrual bleeding with comparable rates of amenorrhea and improvement in subjective scores.
Second generation techniques are associated with shorter operating times and are performed more often under local than general anesthesia. It is not clear if perforation rates differed between second and first generation techniques.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Gynecology" section. You may be interested in Methods of treatment of endometrial hyperplastic processes
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