BJOG. 2000 Apr;107(4):531-4.
Has endometrial ablation replaced hysterectomy
for the treatment of dysfunctional uterine
bleeding? National figures.
Bridgman SA, Dunn KM.
Department of Epidemiology, Keele University
School of Postgraduate Medicine, Stoke-on-Trent,
UK.
Objectives:
To describe trends in the use of
endometrial ablation and hysterectomy for the
treatment of dysfunctional uterine bleeding.
Design:
Analysis of hospital admissions data.
Setting:
National Health Service Hospitals in
England. POPULATION: Women who underwent a
hysterectomy or endometrial ablation for
dysfunctional uterine bleeding between 1989 and
1996. MAIN OUTCOME MEASURES: Annual operation
rates and standardised operation ratios for
England and for the National Health Service
Regions within it, and proportion of operations
for dysfunctional uterine bleeding that were
endometrial ablations or hysterectomies.
Results:
There was an initial rise in operation
rates for endometrial ablation until 1992/3,
since when the rates have fallen. Hysterectomy
rates have remained relatively steady since the
introduction of endometrial ablation. The total
operation rates for dysfunctional uterine
bleeding initially increased but have tended to
fall since 1992/3. The ratio of hysterectomy to
endometrial ablation for dysfunctional uterine
bleeding troughed at 3:1 in 1992/3, but by
1995/6 had increased to 4:1.
Conclusions:
Rather
than replacing hysterectomy in the treatment of
dysfunctional uterine bleeding, endometrial
ablation appears to have added an alternative
operative technique. This led to an increase in
the total number of operations for this
condition, perhaps by lowering the threshold for
intervention.
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