Indications for endometrial resection

To demonstrate that endometrial resection may be used to control abnormal uterine bleeding in a wide variety of clinical conditions.

Sixty-one patients were referred to a private gynaecological practice with abnormal uterine bleeding between January and December 1990. The clinical conditions associated with abnormal uterine bleeding were fibromyomata, adenomyosis, hormone replacement therapy and anticoagulant therapy. Twenty of the patients were referred for consideration of endometrial resection and twelve for consideration of hysterectomy. The advantages and disadvantages of drug therapy, uterine curettage, endometrial resection and hysterectomy were discussed. Forty-two elected to have endometrial resection, thirteen continued with drug therapy after curettage and six proceeded to hysterectomy.

Thirty-five of 42 patients were satisfied with the results of endometrial resection, and 39 of the 42 patients reduced their use of pads or tampons by more than 50%. Three of the failures proceeded to hysterectomy.

The majority of patients with abnormal uterine bleeding not controlled by drug therapy may be suitable for endometrial resection. This includes patients with intramural fibromyomata and adenomyosis. The patient needs to accept a small chance of failure, the risk of complications (particularly uterine perforation) and the fact that the risk of death from the procedure, while small, has not been established.