[Endometrial ablation: prospective 3-year follow-up study]

Patients with persistent uterine bleeding not responsive to conservative therapy may in selected cases opt for endometrial ablation rather than hysterectomy.

50 women with intractable uterine bleeding were subjected to endometrial ablation. 26 patients were treated preoperatively with danazole 200 to 400 mg/day for 4 weeks, 4 received progestins, 5 norethisteron acetas to stop the acute preoperative bleeding and 15 were not given preoperative treatment. Under anaesthesia the cervix was dilated to 10 mm and the uterine cavity was distended with Purisol (sorbitol and mannitol). Roller-ball coagulation technique combined with loop resection was used in 32 patients, resection using the electrosurgical loop in 17 and coagulation with roller ball in 1 patient respectively. The endometrium of the internal os of the uterus was resected in 16 cases. The findings of small uterine myoma(s) were not considered a contraindication of endometrial ablation.

Patients' satisfaction with the effect of treatment was recorded in 48 cases (96%). After 35--5 months 22 (44%) patients reported amenorrhea, 24 (48%) hypomenorrhea, 3 (6%) eumenorrhea and 1 (2%) no change. The mean time of operation was 25 minutes (range 15-40 minutes). The procedure was completed in all 50 women and we had no serious complications.

There was some evidence of superior health related quality of life among hysterectomy patients reported in literature. The rate of secondary hysterectomy was 10% because of associated lesions: myoma with adenomyosis in 50% of the cases, so that the procedure in cases of myoma(s) is questionable. This is the reason why it is necessary to make a careful selection of patients who are to be treated by this metod in order to avoid complications and secondary hysterectomy.

It is concluded, that endometrial ablation is a safe and effective hysteroscopic procedure in cases of abnormal uterine bleeding in women with normal uterine morphological findings or small uterine myoma(s).