Thermal balloon endometrial ablation to treat menorrhagia in high-risk surgical candidates

Objective. To evaluate the safety and efficacy of thermal balloon therapy i n a subset of women with menorrhagia considered to be high-risk surgical ca ndidates for hysteroscopic endometrial ablation or hysterectomy. Design. Prospective, observational study (Canadian Task Force classificatio n 11-2). Setting University-affiliate teaching hospital. Patients. Women with menorrhagia, at high risk because of bleeding disorder s (12), morbid obesity (6), heart-lung transplantation (2), cardiac pacemak er (2), postmenopausal bleeding (8), bowel disease with extensive adhesions and ileostomies (3), cervical stenosis (3), and other medical disorders (9 ). Intervention. Treatment consisted of controlled heating to 87 degrees C of 5% dextrose in water within an intrauterine latex balloon pressurized to 17 0 mm Hg for 8 minutes. General anesthesia was used in 28 patients (60%) and local anesthesia with or without intravenous sedation in 18 (40%). Measurements and Main Results. No intraoperative complication occurred and postoperative morbidity was minimal. Follow-up of 43 women ranged between 6 and 30 months. Overall success of the procedure was 79% (34 patients), wit h 33% reporting amenorrhea, 19% hypomenorrhea, 28% eumenorrhea, and 21% men orrhagia. Conclusion. Thermal balloon endometrial ablation is safe and effective in t reating menorrhagia when other therapies are contraindicated or difficult t o perform.