ENDOMETRIAL ABLATION - AN OPTION FOR THE MANAGEMENT OF MENSTRUAL PROBLEMS IN THE INTELLECTUALLY DISABLED

Objective: To evaluate endometrial ablation as an alternative to hyste rectomy for intellectually disabled women with inadequate menstrual hy giene. Design and setting: A retrospective review of all intellectuall y impaired women referred to a menstrual management clinic at a univer sity teaching hospital for management of inadequate menstrual hygiene between October 1989 and September 1992. Results: Endometrial resectio n 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 ablatio n was performed with roller-ball electrocautery. Three patients underw ent sterilisation at the time of surgery. The mean operating theatre t ime was 75 minutes. Postoperative hospital stay was less than 48 hours for all but one patient, who underwent mini-laparotomy for sterilisat ion - postoperative analgesia was required only by this patient. There were no complications during or after surgery. Six weeks after surger y, all patients were amenorrhoeic and they and/or their carers express ed satisfaction with the procedure. Four women, followed up for betwee n 16 and 38 months, remain amenorrhoeic and two, followed up for six m onths, 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 i s being monitored. Conclusion: Endometrial ablation provides a valuabl e alternative to hysterectomy. It should be the surgical treatment of choice for intellectually disabled women with inadequate menstrual hyg iene unresponsive to medical therapy.