A Comparative Study of Outcome: One and Five Years Following Microwave Endometrial Ablation (MEA)

Dr J Rieley, Dr R Bradnock, Dr J Gemmell, Dr E Megaly, Dr R Lindsay, Dr M Zwizwai

RoyalAlexandraHospital, Paisley.

Introduction

Dysfunctional uterine bleeding (DUB) affects 1 in 20 women aged 30-49 attending primary care (1) (2). It is a common, debilitating problem that can impact greatly on quality of life and can cause anaemia. In secondary care, DUB accounts for 12% of all gynaecology referrals (3). Formerly, hysterectomy – mostly for benign pathology - was performed as definitive treatment. This however is associated with significant morbidity, expense and a longer inpatient stay. Endometrial ablation (MEA) has superseded this is an alternative and established treatment for menorrhagia (4) and is recommended by the National Institute for Clinical Effectiveness (NICE) (5). Analysis of short and medium term results is important to give an up to date indication to patients of the rates of amenorrhoea and satisfaction in that particular unit. This study aimed to assess patient satisfaction 1 and 5 years following MEA treatment and identify those who needed further treatment.

Method

All women undergoing MEA treatment between 2003 and 2008 at the RoyalAlexandraHospital, Paisley, were identified from a prospectively gathered hospital database and sent qualitative postal questionnaires. This was followed up by a case note review of all women, irrespective of response to the questionnaire.

Results

1 year follow up / 5 year follow up
No. of questionnaires / 37 / 37
No. questionnaire returned / 86% (32) / 70% (26)
Treatment for menorrhagia before MEA / 84% (27) / 74% (19)
Amenorrhoea after MEA / 38% (12) / 42% (11)
Lighter periods/overall improvement after MEA / 50% (16) / 81% (21)
Dysmenorrhoea before MEA / 58% (19) / 85% (22)
Dysmenorrhoea after MEA / 19% (6) / 23% (6)
Treatment required after MEA / 16% (6) / 30% (11)
Hysterectomy / 83% (5)
60% (3)for pain
40% (2)for menorrhagia / 64% (7)
29% (2) for pain
29% (2) for menorrhagia

Conclusion

This study shows encouraging rates of amenorrhoea and level of satisfaction and this should reassure patients in the gynaecology clinic when management is discussed. There did not appear to be any defining characteristics of the women whose treatment failed. There are similar outcomes for menorrhagia and dysmenorrhoea at the 1 and 5 year follow up highlighting that MEA is a useful and successful treatment for DUB and a good alternative to more invasive surgery.

References

1. RCOG: Initial Management of Menorrhagia – A National Evidence Based Guideline 2002

2. RCOG: Management of Menorrhagia in Secondary Care – A National Evidence Based Guideline 2002

3. Do British Women Undergo Too Many/Too Few Hysterectomies? Social Science and Medicine, A.Coulter, K. McPherson, M.Vessey, 1998, 27, 987-995

4. A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow up at a minimum of 10 years. Sambrook AM. Bain C. Parker DE. Cooper KG.BJOG 2009; 116 (8): 1033-37.

5. National Institute for Clinical Excellence. Heavy Menstrual Bleeding. NICE Clinical Guideline 44. London: NICE; 2007.