Comparison of microwave endometrial ablation and transcervical resection of the endometrium for treatment of heavy menstrual loss a randomised trial

Background Various new endometrial ablation techniques have emerged for the treatment of menorrhagia. We undertook a randomised controlled trial compa ring one new technique, microwave endometrial ablation (MEA), with a proven procedure, transcervical resection of the endometrium (TCRE), for women wi th heavy menstrual loss. Methods 263 eligible and consenting women, referred for endometrial ablativ e surgery, were randomly assigned MEA (Microsulis plc, Waterlooville, Hamps hire, UK; n=129) or TCRE (n=134). 230 participants were needed to give 80% power of demonstrating a 15% difference in satisfaction with treatment All procedures were done under general anaesthesia 5 weeks after endometrial th inning with goserelin 3.6 mg. Questionnaires were completed at recruitment and at 12 months' follow-up. The primary outcome measures were patients' sa tisfaction with and the acceptability of treatment. Analysis was by intenti on to treat among women followed up to 12 months (n=116 MEA, n=124 TCRE). Findings At 12 months, 89 (77%) women in the MEA group and 93 (75%) in the TCRE group were totally or generally satisfied with their treatment (95% CI for difference -12 to 17) and 109 (94%) versus 112 (90%) found it acceptab le (-11 to 35), Mean operating limes were shorter for MEA than for TCRE (11 .4 vs 15.0 min, p=0.001) and the postoperative stay slightly but not signif icantly shorter. One blunt perforation occurred in each study group resulti ng in one immediate hysterectomy (TCRE group). Of eight health-related qual ity of life dimensions, ail were improved after MEA (six significantly) and seven were improved after TCRE (all significantly). Interpretation Both techniques achieved high rates of satisfaction and acce ptability and both improved quality of life after 1 year. However, we canno t exclude a difference in satisfaction between the groups of less than 15%. MEA seems a suitable alternative to TCRE.