Long-term Impact and Risk Factors for Hysterectomy After Hysteroscopic Surgery for Menorrhagia

Long-term Impact and Risk Factors for Hysterectomy After Hysteroscopic Surgery for Menorrhagia - Pentti K. Heinonen - Riikka Helin - Kari Nieminen For women with menorrhagia, hysteroscopic resection of endometrial tissue, combined with myomectomy and polypectomy when indicated, offers an alternative to hysterectomy. Favorable short-term results have been documented, but the long-term outcome may be less impressive. This study examined long-term outcomes in 279 women with menorrhagia, seen consecutively in the years 1990–1999, who underwent hysteroscopic endometrial resection with or without myomectomy. Follow-up data were available for 259 women, 93% of those operated on, after a mean postoperative interval of 6 years. More than one-third of the women received hormonal therapy for endometrial suppression preoperatively. Operative complications occurred in 15 women, about 6% of the total group. Eight women with postoperative endometritis responded well to antibiotic therapy. Endometrial abnormalities were identified in 41% of cases. One-fourth of women had hysteroscopic resection of fibroids as well, and 9% had polypectomy. Late complications were recorded in nearly 8% of women who were followed up. A large majority of the 18 patients with hematometra had undergone tubal ligation. More than one-third of women had one or more gynecological procedures during follow-up, and 61 of them underwent hysterectomy. Indications for hysterectomy included, in order of declining frequency, myomas, adenomyosis, persistent menorrhagia or endometrial hyperplasia, and perioperative or postoperative complications. More than 80% of hysterectomies were done within 5 years after hysteroscopic surgery. On multivariate analysis, both past tubal ligation and a uterine cavity measuring 9 cm or more in length were associated with an increased risk of hysterectomy. Half of the women who did not require hysterectomy were amenorrheic on long-term follow-up, and none had more than slight menstrual bleeding. These findings show that hysteroscopic resection of endometrium and fibroids provide lasting benefit to women with menorrhagia and is a suitable alternative to hysterectomy. This approach may prove effective for women who have not been satisfied by use of a levonorgestrel-releasing intrauterine system