Thermal endometrial ablation for abnormal uterine bleeding due to endometrial pathology: an alternative to hysterectomy

Abstract

Introduction: Among women of reproductive age Abnormal Uterine Bleeding (AUB) due to a primary endometrial pathology (AUB-E) occurs in up to 25%, and it has a significant adverse impact on their quality of life. In Sri Lanka, hysterectomy continues to be the commonest modality for the treatment of AUB-E not responding to medical therapy. Thermal Endometrial Ablation (TEA) is an alternative option for the management of women with AUB-E. Objective: To describe the effectiveness, short and long term complications, patient satisfaction and cost of TEA in the management of women with AUB-E in Sri Lankan setting. Method: Thirty women with AUB-E underwent TEA under regional anaesthesia at the Academic Department of Obstetrics and Gynaecology of the Teaching Hospital Mahamodara, Galle (THMG) during the period of November 2012 to April 2015. Data was collected using an interviewer administrated questionnaire at discharge, two weeks, three, six, 12 and 24 months post procedure. The effectiveness, short and long term complications, patient satisfaction and cost of TEA in the management of women with AUB-E were studied. Abdominal Hysterectomy (AH) was offered for the patients with treatment failure. Result: Mean age and Body Mass Index of the women were 46 years (SD 4.8) and 25 Kg/m2 (SD 2.3) respectively. Short term minor complications (abdominal cramps, excessive vaginal discharge and vomiting) were observed in three women (10%). There were no major complications. At the end of 12 months, almost half the women were amenorrhoeic with an improvement rate of 90%. At the end of the two years seven ( 23%) had amenorrhoea and 20 (67%) had reduced per vaginal bleeding. Three women underwent AH at three, six and 12 months post procedure respectively, due to treatment failure. The approximate cost of an AH was LKR 49,000. The cost of one TEA device and one TEA installation system were LKR 120,000 and LKR 4,500,000 respectively. Conclusion: TEA was an effective alternative to AH for the treatment of AUB-E, and had no major complications. However, it was more expensive when compared to AH.