Long-term longitudinal assessment of women treated by rollerball endometrial ablation

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Abstract

Objective

To prospectively evaluate the intraoperative outcomes and longitudinally assess, by means of 6-monthly questionnaires, the long-term menstrual symptom relief and satisfaction rates in women with dysfunctional uterine bleeding (DUB) who were treated exclusively by rollerball endometrial ablation (REA).

Design

A prospective study.

Setting

Gynaecology Minimal Access Unit of a large teaching hospital.

Methods

All women undergoing REA between July 1993 and March 1997 (n = 130) were followed up by postal questionnaires approximately every 6 months.

Main outcome measures

Operative details and complications, relief of menstrual symptoms, need for further surgical treatment and satisfaction rates.

Results

Mean age at operation was 40.5 years (95% confidence interval (CI) 39.2-41.7). Mean operation time was 18.4 min (95% CI 16.8-20.3) and mean fluid deficit 142 ml (95% CI 104-180). Of the patients 87% were treated as day cases. For the 6-month periods up to 42 months of follow up, the mean satisfaction rate for women with amenorrhoea, brown discharge or substantially lighter periods was 97% (95% CI 93-100) and the mean rate for women who had complete resolution or less dysmenorrhoea was 90% (95% CI 85-91). An average of 96% (95% CI 91-100) of women were either very satisfied or satisfied with the operation. Four (3.3%) women required repeated REA. There were no differences between each 6-month period for menstrual status, pain and satisfaction rates. Response rate for all questionnaires was 95%. A total of 25 (19.2%) women underwent hysterectomy; five (3.8%) at the time of REA for perforation of uterus, 16 (12.3%) for persistent menorrhagia mainly because of adenomyosis or unsuspected fibroids (mean time after REA 13.3 months; 95% CI 8.8-17.8) and four (3.1%) for other unrelated reasons. Life-table analysis suggests a 17% hysterectomy rate after excluding cases of hysterectomy for other reasons.

Conclusions

REA is a highly effective and successful day-case operation for DUB. Our longitudinal follow-up study shows that the outcome at 6 months seems to be a good predictor of long-term benefit, but continued longer term follow up is required to detect serious complications such as endometrial cancer.

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