Endometrial ablation in the treatment of menorrhagia

Citations from the literature/International

Journal of Gynecology & Obstetrics 49 (199s) 87-97

difficulties with defecation, although the number of patients studied was small. Conclusions: Sacrocolpopexy is a successful operation for the correction of prolapse. Complications include the development of genuine stressincontinence, detrusor instability, voiding difftculty, and mesh infection,

MENORRHAGIA Evaluation of surgical options in menorrhagia Lalonde A. CAN

BR J OBSTET GYNAECOL SUPPL. 1994 101/l I (8-14) Total abdominal and vaginal hysterectomy has been the standard treatment for intractable and unmanageable menorrhagia for many years. However, in the last few years, hysteroscopictreatment of menorrhagia through surgical resection and/or ablation of the endometrial cavity has gained success.Over 625 000 hysterectomies are performed each year in the USA alone. More than 30% are done for menorrhagia as a primary diagnosis. Three times more hysterectomies are performed using the abdominal route than the vaginal approach. Morbidity is higher using the abdominal route alone. Complications of abdominal and vaginal hysterectomies will be briefly discussed.Menorrhagia caused by submucous fibroids can be treated hysteroscopically. A review of methods, complications, advantages and long-term follow up will be presented. Laparoscopically-assisted vaginal hysterectomy (LAVH) is the latest surgical option offered for menorrhagia. The advent of a hysteroscopic approach to the treatment of menorrhagia and careful analysis of the advantages and disadvantages of LAVH will be discussed. Assesment of medical treatments for menorrhagia Shaw R.W. GBR

BR J OBSTET GYNAECOL SUPPL. 1994 101/l I (15-18) Although usually not life-threatening, dysfunctional uterine bleeding (DUB) can causediscomfort and disruption to life for many women. It has been poorly researchedin the past, primarily becauseof difficulties in trying to accurately measureblood loss and response to treatment. There are several different therapies currently available but, for many, actual evidence of their efficacy is lacking from scientific data. Progestogensare the most frequently prescribed drugs for the treatment of DUB. Data support their use in anovulatory women but a number of comparative trials have shown that an overall reduction in blood loss of only 20% is achieved in ovulatory women. Their use,therefore, must be questioned as the first line of treatment. Combined oral contraceptives were at one time popular but whether the low-dose, current generation pills are equally effective awaits appropriate trials. Prostaglandin synthetase inhibitors can be useful, with up to a third of women with menorrhagia benefiting from a reduction of between 25% and 35% in blood loss. A proportionally greater reduction is seen in women with more excessivebleeding. Antilibrinolytic drugs have been shown to reduce menstrual blood loss in DUB by

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50%and would be useful in women in whom estrogensare contraindicated. Gonadotrophin-releasing hormone analogues are highly effective becauseof their ability to induce amenorrhea, but long-term use is contraindicated because of their hypoestrogeniceffects. One other effective therapy for menorrhagia has been danazol. At a dosage of 200 mg daily, danazol has been shown to be highly effective in several open and randomized comparative trials, with a consistent reduction of blood loss of up to 75% being achieved with maintenance of a regular menstrual cycle. Reducing the dose to 100 mg daily often results in cycle irregularities, whereas increasing the dose to 400 mg daily induces amenorrhea. A daily dose of 200 mg of danazol is well tolerated and should be considered as a first-line option in DUB presenting as menorrhagia requiring medical management. Endometrial ablation in the treatment of menorrhagia Erian J. GBR

BR J OBSTET GYNAECOL SUPPL. 1994 101/l I (19-22) A prospective 5-year multicenter study, involving three UK gynecology centres with a special interest in endoscopic laser surgery, was set up to determine the safety, acceptability, clinical effectiveness and complications of neodymium yttriumaluminium-garnet laser ablation of the endometrium in the treatment of menorrhagia. A total of 2342 women with disabling menorrhagia that was unresponsive to medical therapy were involved. The main outcome measureswere: preoperative endometrial preparation, duration of laser ablation, intra- and postoperative complications, amenorrhea rate, oligomenorrhea rate, and the women’s subjective assessmentof treatment. No major complications occurred in the 2342 treatments, Nine (0.4%) casesof transient fluid overload, II (0.5%) of infection and live (0.2%) of uterine perforation occurred. None of the women required a laparotomy. The mean duration of the laser ablation was 24 min. The post-surgery amenorrhea rate was higher in women pretreated with danazol. Of the 1866women followed up for at least I year after treatment, 1043 (56%) developed complete amenorrhea, 701 (38%) reported continuing but satisfactorily reduced menstruation, and 122(7%) patients failed to improve with the first treatment (57 of these 122 women responded to a second laser ablation). Overall, 1744 (93%) had a satisfactory responseto laser ablation and only 33 (1.8%) required subsequent hysterectomy. In conclusion, this study showed that hysteroscopic endometrial laser ablation is an acceptable alternative to hysterectomy for the treatment of menorrhagia.

EXPERIMENTAL

GYNECOLOGY

Characterization of epidermal growth factor receptor in human endometrial cells in culture Watson H.; Franks S.; Bonney R.C. GBR

J REPROD FERTIL 1994 lOl/2 (415-420) The aim of the study was to determine the binding characteristics of the epidermal growth factor (EGF) receptor