One-stage endometrial ablation: results in 200 cases

Until now, endometrial ablation (EA) included at least three steps: (1) D & C or hysteroscopic endometrial sampling; (2) Danazol treatment; and (3) the ablation. We have found that step (2) can be omitted if EA is performed between days 2-7 of the menses. This permits to combine steps (1) and (3) into a single stage EA which is a very simple, feasible, efficient and safe treatment for dysfunctional bleeding. Simple: because one stage without hormonal pretreatment, causing almost no pain and only a minimal time off work. It is not more of a burden than D & C with hysteroscopy. General anaesthesia is used in 94% of our patients. Feasible: in one case only (GOPO) the cervix could not be dilated wide enough. Efficient: good results in 97.5%: 67% complete amenorrhea, 24% slight menstrual spotting for a maximum of 2 days, 6% reduced flow and 0.5% normal flow. There are 2.5% failures. When menorrhagia is accompanied by otherwise unexplained dysmenorrhea, the pain is completely cured in 73%, unchanged in 7% and greatly improved in 20%. Safe: mild complications in 2.5% only. We have also combined the two main methods of endometrial destruction: electrocoagulation and Nd/Yag laser. Our 97.5% good results, however, is not a definite proof that a combination of these two techniques is better than either technique alone.