THE RELATIONSHIP BETWEEN PREOPERATIVE ENDOMETRIAL THICKNESS, THE ANTEROPOSTERIOR DIAMETER OF THE UTERUS AND CLINICAL OUTCOME FOLLOWING TRANSCERVICAL RESECTION OF THE ENDOMETRIUM

The objective of this study was to identify whether the endometrial th ickness, or the anteroposterior diameter of the uterus as assessed by transvaginal ultrasonography (TVS), could be used to predict the clini cal outcome following transcervical resection of the endometrium (TCRE ). An open observational trial was carried out, involving 195 consecut ive patients undergoing TCRE, 188 of whom completed follow-up. The pat ients were examined by TVS preoperatively, and then 6 weeks, 6 months and 1 year following TCRE. In all examinations, endometrial thickness. the anteroposterior diameter and residual endometrium, uterine morpho logy and the clinical outcome as measured by pain reduction, bleeding index and amenorrhea were assessed. Patients with a preoperative endom etrial thickness of 8 mm or less had a higher rate of amenorrhea after 1 year than patients with an endometrial thickness exceeding 8 mm. Ou tcome did not relate to the histological phase of the endometrium obta ined during resection. Neither the uterine anterposterior diameter, or the presence of submucous fibroids, had any influence on the clinical outcome. Cavity fluid was observed in some cases but was not always a ssociated with symptoms. Residual endometrium could be detected by TVS in 38% of the women after 1 year, but the vast majority of these pati ents reported a satisfactory outcome from the procedure. We conclude t hat the size of the anteroposterior diameter does not affect the clini cal outcome of TCRE, whilst the preoperative endometrial thickness doe s have a significant impact on the likelihood of achieving amenorrhea after 1 year. The data suggest that TCRE should preferably be performe d when the endometrium is at its thinnest and that there may be a usef ul role for agents that produce endometrial atrophy prior to surgery.