Uterine balloon therapy to treat menorrhagia

Objective: To study the clinical efficacy, safety and acceptability of the thermal balloon endometrial ablation (TBEA) in patients with dysfunctional uterine bleeding. Methods: Thirteen patients with DUE who did not respond t o medical treatment and dilatation and curettage consented to a trial of TB EA with EASY(TM) model of balloon catheter by Gynecare. All procedures were done under intravenous (IV) sedation and paracervical block. Patients were mostly discharged within 48 h. Follow-up of 2-19 months is reported. Trans vaginal ultrasound and hysteroscopy were performed in six patients after 6 months of TBEA. Results: Twelve patients (92.5%)reported a significant redu ction in bleeding. Two patients (15.4%) experienced amenorrhea. Only two pa tients (15.4%) underwent subsequent hysterectomy, one for persistent menorr hagia and the other for severe pelvic pain. In successful patients of TBEA, transvaginal ultrasonography revealed marked reduction in endometrial thic kness and no endometrium was visible in one patient who had developed ameno rrhea. In successful cases follow-up hysteroscopy revealed scarring in more than two-thirds of the endometrium. Conclusions: Thermal balloon endometri al ablation is a safe, simple, effective, easy and minimally invasive proce dure which can be done under IV sedation and paracervical block in an offic e setting. It has several advantages over hysterectomy, including preservat ion of the uterus, avoidance of surgical incision and potential to perform on an outpatient basis. It is a good alternative to hysteroscopic endometri al ablation with a comparable success rate with minimal risk and no limitin g factors except the cost of the balloons. However, large scale randomized controlled studies are needed with TBEA and other endometrial ablation proc edures. (C) 1998 International Federation of Gynecology and Obstetrics.