Treatment of recurrent bleeding disorders during hormone replacement therapy by transcervical endometrial ablation

If bleeding disorders, which could not be treated by modification of steroid dosages, occurred during sequential hormone replacement therapy (HRT), most of the patients stopped HRT. In these cases a diagnostic outpatient hysteroscopy with biopsy was carried out. In most of the cases no intrauterine cause for the bleeding disorder was found. In 35 patients we performed an endometrial ablation without intra- or postoperative complications. After this procedure all patients received a combined continuous HRT. In a follow-up of 12 months 34 patients were amenorrheic and satisfied with the treatment. One patient stopped HRT because of suffering from other side effects. Endometrial ablation represents a method of treating patients with bleeding disorders without intrauterine causes with a minimal invasive procedure. A continuous combined HRT is possible after the endometrial ablation in perimenopausal and postmenopausal patients without bleeding disorders. In selected cases endometrial ablation can contribute to the increase of the compliance with HRT.