Improving results of hysteroscopic submucosal myomectomy for menorrhagia by concomitant endometrial ablation.

STUDY OBJECTIVE

To evaluate the effect of endometrial ablation on the outcome of premenopausal patients undergoing hysteroscopic myomectomy for menorrhagia or menometrorrhagia

DESIGN

Retrospective cohort study (Canadian Task Force classification II-2).

SETTING

Private practice.

PATIENTS

One hundred seventy-seven women with one or more submucosal myomas experiencing menorrhagia or menometrorrhagia.

INTERVENTION

Hysteroscopic myomectomy without endometrial ablation in 104 patients and with concomitant endometrial ablation in 73 patients.

MEASUREMENTS AND MAIN RESULTS

Bleeding was controlled in 95.9% of patients with endometrial ablation and in 80.8% of patients without endometrial ablation (p = .003). Complete removal of the myoma led to better results (p = .039), which were further improved by endometrial ablation (p = .022). Endometrial ablation improved bleeding in patients whose myomas could not be completely removed, but the difference was not statistically significant (p = .23). Subsequent hysterectomies were not decreased by endometrial ablation (p = .48) or by complete removal of the myoma (p = .83). Hysterectomies for bleeding problems were decreased by endometrial ablation. Pain and dysmenorrhea were a frequent cause of hysterectomy.

CONCLUSION

Endometrial ablation at the time of hysteroscopic myomectomy improves results in the control of bleeding.