A RANDOMIZED COMPARISON OF MEDICAL AND HYSTEROSCOPIC MANAGEMENT IN WOMEN CONSULTING A GYNECOLOGIST FOR TREATMENT OF HEAVY MENSTRUAL LOSS

Objectives To compare medical with hysteroscopic management in women r eferred to a gynaecologist complaining of heavy menstrual loss. Design Single-centre randomised trial. Setting A teaching hospital in the Un ited Kingdom. Participants One hundred and ninety-seven women seeking specialist treatment of heavy menstrual loss for the first time and wi lling to accept either treatment. Interventions 1. Medical treatments not previously used by the women prescribed by experienced gynaecologi sts in standard doses and timings for a minimum of three cycles (n = 9 4), and 2. transcervical resection of the endometrium performed under general anaesthesia five weeks after goserelin preparation (n = 93). M ain outcome measures Treatment satisfaction and acceptability, relief of symptoms, change in haemoglobin, and improvement in health related quality of life, all after four months. Results Women allocated transc ervical resection were more likely to be totally or generally satisfie d (76% versus 27%, P < 0.001), to find the treatment: acceptable (93% versus 36%, P < 0.001), and willing to have the treatment again (93% v ersus 31%, P < 0.001). Although pain and bleeding were significantly r educed by medical treatment this was modest in comparison with transce rvical resection (P < 0.001). Haemoglobin levels were significantly in creased only following transcervical resection. Short form 36 scores w ere also improved in both arms, although only transcervical resection returned them to normal values. Conclusions Medical treatment was less effective than transcervical resection of the endometrium, irrespecti ve of previous treatment or type of medical management. Early hysteros copic endometrial surgery should be considered by such woman with the choice made by the woman after a full discussion of the advantages and disadvantages of all the options.