A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years

Objective To assess the long term impact of initial management by endometri al ablation for women with dysfunctional uterine bleeding who would otherwi se have had a hysterectomy. Design Long term follow UP Of randomised cohorts of women. Setting Gynaecology department of a large teaching hospital. Sample Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously, Methods Postal questionnaire and case note review. Main outcome measures Wo men's satisfaction with treatment, gynaecological symptoms and psychologica l outcomes at four years; further surgical treatment and differential resou rce use at a minimum of four years' follow up. Results Further surgical treatment was received by 39 (38%) women randomise d to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical tr eatment by any method was 36% and by hysterectomy was 24% (compared with 29 % and 14% respectively at one year). Satisfaction rates were high (80% abla tion group vs 89% hysterectomy group), the difference reflecting re-treatme nt. Premenstrual symptoms improved over time but more so in the hysterectom y group, who also rated their improvements in general health higher. The es timated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (pound 1231 vs pound 1332). Conclusions While about two out of every five women allocated to endometria l ablation eventually received further surgical treatment, hysterectomy wit h its associated morbidity was still avoided by 76% of women with dysfuncti onal uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.