RANDOMIZED TRIAL OF HYSTERECTOMY, ENDOMETRIAL LASER-ABLATION, AND TRANSCERVICAL ENDOMETRIAL RESECTION FOR DYSFUNCTIONAL UTERINE BLEEDING

Objective-To evaluate the effectiveness and safety of endometrial lase r ablation and transcervical resection of the endometrium compared wit h hysterectomy in the surgical treatment of women with dysfunctional u terine bleeding. Design-Prospective randomised controlled trial. Setti ng-Gynaecology department of a large teaching hospital. Subjects-204 w omen who would otherwise have been undergoing hysterectomy for menorrh agia were recruited between August 1990 and March 1992 and randomly al located to hysterectomy (n=99) or conservative (hysteroscopic) surgery (transcervical resection (n=52) and laser ablation (n=53)). Main outc ome measures-Operative complications, postoperative recovery, relief o f menstrual and other symptoms, patient satisfaction with treatment af ter six and 12 months. Results-Women treated by hysteroscopic surgery had less early morbidity and a significantly shorter recovery period t han those treated by hysterectomy (median time to full recovery 2-4 we eks a 2-3 months, P < 0.001). Twelve months later 17 women in the hyst eroscopy group had had a hysterectomy, 11 for continuing symptoms; 11 women had had a repeat hysteroscopic procedure; 45 were amenorrhoeic o r had only a brown discharge; and 35 had light periods. Dysmenorrhoea and premenstrual symptoms improved in most women in both groups. After 12 months 89% (79/89) in the hysterectomy group and 78% (75/96) in th e hysteroscopy group were very Satisfied with the effect of surgery (P < 0.05); 95% (85/89) and 90% (86/ 96) thought that there had been an acceptable improvement in symptoms, and 72% (64/89) and 71% (68/96) wo uld recommend the same operation to others. Conclusions-Hysteroscopic endometrial ablation was superior to hysterectomy in terms of operativ e complications and postoperative recovery. Satisfaction after hystere ctomy was significantly higher, but between 70% and 90% of the women w ere satisfied with the outcome of hysteroscopic surgery. Hysteroscopic surgery can be recommended as an alternative to hysterectomy for dysf unctional uterine bleeding.