Safety and efficacy of hysteroscopic endomyometrial resection-ablation for menorrhagia

To assess the safety and efficacy of endomyometrial resection-ablation as a surgical means of treating patients with chronic, debilitating menorrhagia.

A retrospective review was carried out of the records of 70 consecutive women of reproductive age who had severe uterine bleeding, who did not wish to retain their reproductive potential and who were managed uniformly at Wyckoff Heights Medical Center from July 1993 to March 1999 by operative hysteroscopy and endomyometrial resection-ablation under laparoscopic control. Demographic data were collected, and details of the clinical course were assessed for complications of the procedure. The patients were followed for an average of 24 months to evaluate how effective this technique was for correcting the bleeding problem.

Immediate postoperative amenorrhea occurred in nearly all cases (97.1%). It lasted for only three months in most cases, but persisted for as long as eight months in a small number (5.7%). Some degree of hypomenorrhea was reported for as long as eight months in 88.6%. Overall, almost every women reported feeling better (94.3%). Uterine perforation occurred in 8.6%, one case of which was compounded by bladder and ureteral injury. One patient experienced fluid overload. Histopathologic examination of the endometrium obtained intraoperatively showed the range of benign conditions that were associated with the bleeding problems for which these women had sought care.

Operative hysteroscopy and endomyometrial resection-ablation was safe and effective for surgical management of persistent, severe menorrhagia. Patients were largely satisfied with the results. Transient amenorrhea and hypomenorrhea occurred frequently. There was a satisfactory correlation between preoperative and postoperative histopathologic findings. No endometrial malignancy was missed. Fluid overload was almost entirely averted as a significant complication.