A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia.
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This randomized trial found endometrial resection to be a shorter, less expensive procedure with faster recovery than abdominal hysterectomy for menorrhagia, though some women required repeat procedures.
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Abstract
OBJECTIVE: To determine the advantages and disadvantages of endometrial resection and abdominal hysterectomy for the surgical treatment of women with menorrhagia. DESIGN: Randomised study of two treatment groups with a minimum follow up of nine months. SETTING: Royal Berkshire Hospital, Reading. SUBJECTS: 51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy. TREATMENT: Endometrial resection or abdominal hysterectomy (according to randomisation). Endometrial resections were performed by an experienced hysteroscopic surgeon; hysterectomies were performed by two other gynaecological surgeons. MAIN OUTCOME MEASURES: Length of operating time, hospitalisation, recovery; cost of surgery; short term results of endometrial resection. RESULTS: Operating time was shorter for endometrial resection (median 30 (range 20-47) minutes) than for hysterectomy (50 (39-74) minutes). The hospital stay for endometrial resection (median 1 (range 1-3) days) was less than for hysterectomy (7 (5-12) days). Recovery after endometrial resection (median 16 (range 5-62) days) was shorter than after hysterectomy (58 (11-125) days). The cost was 407 pounds for endometrial resection and 1270 pounds for abdominal hysterectomy. Four women (16%) who did not have an acceptable improvement in symptoms after endometrial resection had repeat resections. No woman has required hysterectomy during a mean follow up of one year. CONCLUSION: For women with menorrhagia who have no pelvic pathology endometrial resection is a useful alternative to abdominal hysterectomy, with many short term benefits. Larger numbers and a longer follow up are needed to estimate the incidence of complications and the long term efficacy of endometrial resection.
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Cited by (31)
- Prise en charge des ménorragies : recommandations pour la pratique clinique du Collège national des gynécologues et obstétriciens français (CNGOF) 2022
- Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review 2022
- Menstrual Problems for the MRCOG and Beyond 2014
- Cost-utility of levonorgestrel intrauterine system compared with hysterectomy and second generation endometrial ablative techniques in managing patients with menorrhagia in the UK 2007
- Dispelling the myth—does hysterectomy cause pelvic organ dysfunction? 2004
- Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia 2003
- Current treatment of dysfunctional uterine bleeding 2003
- Economic evaluation of three surgical interventions for menorrhagia 2003
- Evidence and techniques in endometrial ablation: consensus 2002
- Evidence and techniques in endometrial ablation: consensus 2002
- A cost effectiveness analysis of goserelin compared with danazol as endometrial thinning agents 2000
- Vaginal hysterectomy for the woman with a moderately enlarged uterus weighing 200 to 700 grams 1999
- Hysterectomy as treatment for dysfunctional uterine bleeding 1999
- Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: literature review 1998
- Endometrial Ablative Techniques in the Climacteric Woman 1998
- A survey of women's preferences regarding alternative surgical treatments for menorrhagia 1998
- Dysfunctional uterine bleeding. 1998
- Medical Research Council randomised trial of endometrial resection versus hysterectomy in management of menorrhagia 1997
- 4 Indications and alternatives to hysterectomy 1997
- Endometrial Resection for the Treatment of Menorrhagia 1996
- Menorrhagia: a clinical update 1996
- 4 Endometrial resection 1995
- Good practice with endometrial ablation 1995
- Managing menorrhagia. 1995
- 9 Audit of currently available endometrial ablative techniques 1995
- Transcervical Resection of the Endometrium Using Intracervical Block Only A Review of 278 Procedures 1994
- Evaluation of surgical options in menorrhagia 1994
- An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia 1993
- The histopathology of transcervical resection of the endometrium: an analysis of 200 cases 1993
- Minimally invasive endometrial surgery 1992
- Management of uncontrolled menorrhagia with the resectoscope 1992
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