The neodymium:YAG laser and the resectoscope for the treatment of menorrhagia.

OBJECTIVE

To assess the efficacy of destruction of the endometrium by ablation with a neodymium:YAG laser or resection with electrocautery in the management of menorrhagia.

DESIGN

The efficacy of the treatment was assessed subjectively by each patient comparing the duration and amount of her menstrual bleeding before and after the operative procedure. Randomisation of treatments or patients was not undertaken.

SETTING

The study was carried out in tertiary centres. Most of the procedures were undertaken in the Day Surgery Units of those centres.

PATIENTS

A total of 64 patients underwent one or more procedures. One had continuous bleeding per vagina on hormone replacement therapy, all others had menorrhagia which they considered incapacitating.

INTERVENTIONS

Of the patients 40 had removal of endometrium via a resectoscope and 24 had endometrial vaporisation with the neodymium:YAG laser.

MAIN OUTCOME MEASURE

The outcome was assessed by each patient as amenorrhoea, hypomenorrhoea, attainment of normal menstrual amount or no change in menstrual loss.

RESULTS

Both operative procedures were satisfactory in that amenorrhoea, hypomenorrhoea or normal menstruation was achieved in 87% of cases. Uterine perforation occurred on two occasions with thermal bowel injury in one patient.

CONCLUSION

Destruction of the endometrium by the neodymium:YAG laser or the resectoscope is a successful way of managing menorrhagia in the absence of demonstrable pathological cause in nearly 90% of cases. The performance of the procedures as day cases with minimal discomfort makes them attractive alternatives to hysterectomy in the management of menorrhagia.