A PRAGMATIC RANDOMIZED COMPARISON OF TRANSCERVICAL RESECTION OF THE ENDOMETRIUM WITH ENDOMETRIAL LASER-ABLATION FOR THE TREATMENT OF MENORRHAGIA

Objective To compare endometrial laser ablation (ELA) with transcervic al resection of the endometrium (TCRE) in the treatment of menorrhagia . Design Randomised controlled trial. Setting Gynaecology department o f a large teaching hospital. Participants Women with menorrhagia due t o dysfunctional uterine bleeding (n = 372) were randomly allocated to ELA (n = 188) or TCRE (n = 184). Main outcome measures Operative compl ications, post-operative recovery, relief of menstrual and other sympt oms, need for further surgical treatment, satisfaction with treatment after 6 and 12 months, and differential resource use. Results TCRE was significantly quicker, with lower rates of fluid overload. Perioperat ive morbidity was low and similar in both groups. Outcome at 12 months was also similar: 72 women (45%) had either amenorrhoea or brown disc harge in the ELA group compared with 71 (49%) in the TCRE group; 79 (4 9%) versus 68 (46%) had lighter periods. Thirty (16%) versus 36 (20%) had received further surgical treatment: 9 (5%) compared with 25 (14%) had had a hysterectomy, and 21 (11%) versus 11 (6%) had received repe at ablation. Anxiety and depression, dysmenorrhoea and pre-menstrual s ymptoms were improved by both procedures and bladder symptoms were aff ected by neither. At 12 months 148 (90%) women in the ELA group and 14 0 (91%) women in the TCRE group were satisfied with their treatment. T he estimated additional cost of ELA was pound 145 per procedure. Concl usions At one year there was no clear difference in clinical outcome b etween ELA and TCRE. Both procedures were associated with low morbidit y. ELA was the more costly procedure. Despite the need for further sur gery for about one in six women, satisfaction rates were high followin g both ELA and TCRE.