Reply

Sir, We thank you for the opportunity to comment on the issues raised by Belanger and El Din from Wallsten Medical SA with reference to our recent article on endometrial thermoablation (Vihko et al., Acta Obstet Gynecol Scand 2003; 82: 269–74). The methods part of our article does contain two errors as pointed out by Belanger and El Din. With the Cavaterm system, glycine was in fact used at the temperature recommended by the manufacturer. Similarly, we maintained the pressure with Cavaterm at or slightly above 200 mmHg; occasional decreases in pressure do happen, however, in clinical practice. These decreases were, however, immediately corrected during the procedure. For selected patients, we performed hysterosonography if the ultrasound scan findings were inconclusive. Hysteroscopy was not performed as it could not be carried out in the hospital's outpatient unit. In our practice (about 400 thermoablation procedures) we rarely see complete amenorrhea after thermoablation. Most patients will experience at least some menstrual spotting after these procedures. The key finding, however, is that most patients are satisfied with this as the postoperative result. Therefore, we consider endometrial thermoablation to be a good choice for patients suffering from idiopathic menorrhagia.