Endometrial ablation: an option for the management of menstrual problems in the intellectually disabled

To evaluate endometrial ablation as an alternative to hysterectomy for intellectually disabled women with inadequate menstrual hygiene.

A retrospective review of all intellectually impaired women referred to a menstrual management clinic at a university teaching hospital for management of inadequate menstrual hygiene between October 1989 and September 1992.

Endometrial resection was considered an appropriate alternative to hysterectomy for eight intellectually disabled women. To date, seven women have undergone the procedure and one is receiving medical treatment. Endometrial ablation was performed with roller-ball electrocautery. Three patients underwent sterilisation at the time of surgery. The mean operating theatre time was 75 minutes. Postoperative hospital stay was less than 48 hours for all but one patient, who underwent minilaparotomy for sterilisation--postoperative analgesia was required only by this patient. There were no complications during or after surgery. Six weeks after surgery, all patients were amenorrhoeic and they and/or their carers expressed satisfaction with the procedure. Four women, followed up for between 16 and 38 months, remain amenorrhoeic and two, followed up for six months, have each experienced one episode of spotting but are otherwise amenorrhoeic. The seventh patient has had irregular bleeding but this is deemed due to erroneous continuation of progesterone therapy and is being monitored.

Endometrial ablation provides a valuable alternative to hysterectomy. It should be the surgical treatment of choice for intellectually disabled women with inadequate menstrual hygiene unresponsive to medical therapy.