MEDICAL-RESEARCH-COUNCIL RANDOMIZED TRIAL OF ENDOMETRIAL RESECTION VERSUS HYSTERECTOMY IN MANAGEMENT OF MENORRHAGIA

Background The most frequent indication for hysterectomy is menorrhagi a, even though the uterus is normal in a large number of patients. Tra nscervical resection of the endometrium (TCRE) is a less drastic alter native, but success rates have varied and menorrhagia can recur. We ha ve tested the hypothesis that the difference in the proportion of wome n dissatisfied and requiring further surgery within 3 years of TCRE or hysterectomy would be no more than 15%. Methods 202 women with sympto matic menorrhagia were recruited to a multicentre, randomised, control led trial to compare the two interventions. TCRE and hysterectomy were randomly assigned in a ratio of two to one. The primary endpoints wer e women's satisfaction and need for further surgery. The patients' psy chological and Social states were monitored before surgery, then annua lly with a questionnaire. Analysis was by intention to treat. Findings Data were available for 172 women (56 hysterectomy, 116 TCRE); 26 wit hdrew before surgery and four were lost to follow-up. Satisfaction sco res were higher for hysterectomy than for TCRE throughout follow-up (m edian 2 years), but the differences were not significant (at 3 years 2 7 [96%] of 28 in hysterectomy group vs 46 [85%] of 54 in TCRE group we re satisfied; p=0.16). 25 (22%) women in the TCRE group and five (9%) in the hysterectomy group required further surgery (relative risk 0.46 [95% CI 0.2-1.1], p=0.053). TCRE had the benefits of shorter operatin g time, fewer complications, and faster rates of recovery. Interpretat ion TCRE is an acceptable alternative to hysterectomy in the treatment of menorrhagia for many women with no other serious disorders.