Ultrasonographic and hysteroscopic follow up after transcervical resectionof the endometrium

Objective Long-term follow-up of women who have undergone transcervical res ection of the endometrium (TCRE), and evaluation of the uterine endometrium and cavity in these women. Design Transvaginal ultrasound examination (TVS) with hydrosonography and h ysteroscopy, including biopsies, was carried out in 61 women, 19-67 months (mean 40 months) after transcervical endometrial resection. Results The age range of the women was 37-58 years (mean 48 years). Of 61 w omen, 67% had amenorrhoea or hypomenorrhoea, 28% had withdrawal bleeding of normal amounts and three women suffered from polymenorrhoea. Of 40 women w ith dysmenorrhoea before treatment, 18 still had cyclic pain afterwards. In three women, dysmenorrhoea developed postoperatively. At ultrasound examin ation, an echo from the uterine cavity was found in 95% of the women and an echo of 5 mm or more was seen in 22%. Crypts and occlusions were present i n 19% and synechiae in 4% of the women. For technical reasons, hydrosonogra phy could not easily be done. At hysteroscopy signs of endometrium were fou nd in 85% of the women, and synechiae were present in all women. The uterin e cavity was partly occluded and narrowed. One woman bad a total occlusion of the uterine cavity. Histopathological examination of the biopsies or cur ettage specimens from the uterine cavity showed endometrial tissue in 67% o f the women. Conclusions Residual endometrium was found in most women after TCRE and, th erefore, if hormone replacement therapy is to be used, a combination of oes trogen with gestogen should be recommended. Intracavitary synechiae were pr esent in most women after TCRE. The synechiae may have contributed to the c yclic pain experienced by 20 women after treatment. However, the synechiae did not seem to conceal the withdrawal bleeding or menstruation. If women w ho have undergone TCRE develop symptoms such as bleeding and/or pain, both vaginal ultrasound and hysteroscopy with directed biopsies should be recomm ended.