Fluid absorption and the long-term outcome after transcervical resection of the endometrium

Fluid absorption may cause symptoms of acute volume overload and has also been associated with a less favorable outcome after endometrial resection. To further study this topic, we evaluated the incidence of fluid absorption, the factors associated with absorption, and the relationship between fluid absorption and the long-term outcome after TCRE.

Two hunded and sixty-five women underwent TCRE in which the absorption of irrigating fluid (glycine 1.5%) was measured volumetrically. Physical examinations were made and questions about menstrual blood loss and cyclic pelvic pain were asked before the operation and 12 weeks and 1, 2, and 3 years later.

Fluid absorption was increased in patients treated with a GnRH analogue (leuprolide acetate) prior to the TCRE (p<0.007) and also when a submucous myoma was removed during the operation (p<0.0001). About 40% of the women operated on still had menstrual bleeds 1 year later, and this correlated with a larger fluid absorption (p<0.04). Dysmenorrhea disappeared in half the patients, while 17% of those who were pain-free before the TCRE had developed cyclic pelvic pain at 1 year, an outcome also associated with a larger fluid absorption (p<0.02). Pain correlated with lower patient satisfaction, preserved menstrual bleeds, and with the presence of remnants of endometrial tissue as imaged by transvaginal ultrasonography.

Resection of a submucous adenoma increases the risk of fluid absorption during TCRE. The results also indicate that fluid absorption is associated with persistent menstrual bleeding and late development of cyclic pelvic pain.