Hysterectomy and Endometrial Ablation Compared

234 patients with menorrhagia were treated hysteroscopically by transcervical resection of the endometrium (TCRE) instead of hysterectomy. 250 procedures were performed under general anaesthesia (63%) or under sedation plus local anaesthesia (38%). The endometrium was excised either totally (91%) or partially (9%) in all but one case, and 56 (22%) of the patients underwent simultaneous resection of submucous fibroids. Surgical time (range 10-100 min) varied with the gynaecologist's experience. 479 ml was the average volume of uterine irrigant absorbed by the patient. Blood loss was usually slight. Operative complications were uncommon, but 4 (2%) women sustained a uterine perforation (without serious se quelae), 7 (3%) absorbed more than 2 litres of fluid, and 1 required tamponade to control postoperative bleeding. Hospital stay was short and full recovery usual by 1-2 weeks. Menstrual symptoms improved in over 90% of the patients throughout the follow-up of up to 2 [half] years; 27-42% of the women became amenorrhoeic at some time after total TCRE. Results were best in women > 35 years of age, but was not influenced by the presence of fibroids or pretreatment dysmenorrhoea. 10 (4%) women later underwent hysterectomy. Hysteroscopy 3 and 12 months after surgery revealed a small, fibrotic uterine cavity in the majority.

Please click on the required question.

• 1 Are heavy periods a common problem?
• 2 What is in my menstrual flow?
• 3 What range of menstrual cycle length is considered to be normal?
• 4 How can menstrual blood loss be measured?
• 5 How can I tell if my periods are abnormally heavy?
• 6 What could be the cause of my very heavy menstrual periods?
• 7 I have been sterilised. Could this be the cause of my heavy periods?
• 8 Should I have tests to find the reason for my heavy periods?
• 9 How will my heavy period problems be investigated?
• 10 What is meant by anaemia due to heavy periods?
• 11 What is intermenstrual bleeding?
• 12 What is a hysteroscopy and D and C?
• 13 What is cervical cautery?
• 14 What happens after the D and C?
• 15 What treatments are available for my heavy periods?
• 16 What are the medical treatments available for heavy periods?
• 17 How do the various medical treatments for heavy periods work?
• 18 What would be reasonable initial treatment for a teenager or young woman with heavy periods?
• 19 What is a hysterectomy?
• 20 What are the indications for hysterectomy?
• 21 What are the risks (complications) of hysterectomy?
• 22 What is vault granulation?
• 23 What are the different types of hysterectomy?
• 24 Is it essential to remove the neck of the womb at hysterectomy?
• 25 Should my ovaries be removed or conserved during hysterectomy?
• 26 How long will I be in hospital when I have my hysterectomy?
• 27 I have had a hysterectomy. Do I still need to have smear tests?
• 28 What are the other surgical alternatives to hysterectomy?
• 29 How do endometrial ablation and hysterectomy compare?
• 30 Are there any psychological effects following hysterectomy?
• 31 How do we decide the best treatment for my period problems?
• 32 Could I have some recommended hysterectomy support groups?
• 33 Are there any support groups?
• Intermenstrual Bleeding - Bleeding between periods.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.