Endometrial ablation
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Endometrial ablation is a validated treatment, but newer techniques require more long-term data on efficacy, safety, and cost-effectiveness, with hysterectomy rates not declining as anticipated.
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Abstract
Purpose of review Although endometrial ablation has now been accepted practice for more than 20 years, it continues to be a source of research, controversy and speculation. This is illustrated by the 175 articles found in PubMed between the years 2000 and 2003 under the search term ‘endometrial ablation’ commissioned as part of the preparation for this article. Recent findings The so-called first-generation methods (laser, resection, rollerball) have now got long-term follow-up data of up to 20 years. A few of the second-generation devices have published long-term follow-up data of 5 years. All of the second-generation devices assessed in randomized trials with the first-generation methods compare favourably; however, there are few data on cost effectiveness. Similarly, there are few data comparing endometrial ablation with the Mirena intrauterine device. Summary Conventional endometrial ablation has been extensively validated; however, many of the newer techniques have inadequate patient numbers or lengths of follow-up on which to evaluate their long-term efficacy, safety or cost effectiveness fully. The anticipated decline in hysterectomy rates with the advent of endometrial destruction methods has not occurred, and this may indicate a lower threshold for surgical management.
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Too few in-corpus citations on either side for a chart; here are the lists.
Cites (4)
- Do British women undergo too many or too few hysterectomies? 1988
- A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia. 1991
- Medical Research Council randomised trial of endometrial resection versus hysterectomy in management of menorrhagia 1997
- Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia 2003
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