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Emslie E, Mui J, Sullivan MB, Karreman E, Buitenhuis D, Berscheid K, Rattray D. Evaluation of Radiofrequency Endometrial Ablation: A 17-year Canadian Experience. J Minim Invasive Gynecol 2023; 30:905-911. [PMID: 37451502 DOI: 10.1016/j.jmig.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/13/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
STUDY OBJECTIVE The purpose of this study was to better elucidate radiofrequency endometrial ablation (REA) durability by assessing the probability of failure as defined by need for postablation hysterectomy. Age at index REA, duration from REA until hysterectomy, and REA failure (REAF) risk factors were analyzed. DESIGN A retrospective cohort study was conducted using patient data between April 1, 2002, and March 31, 2019. REAF cases were identified using operative procedure codes. Cox proportional hazard regression assessed the effect of age at index REA on time to postablation hysterectomy. Kaplan-Meier survival curve evaluated timing of postablation hysterectomy, stratified by age at index REA. SETTING This study was conducted at Regina General Hospital in Regina, Saskatchewan, Canada. PATIENTS Patient population included those who were 21 years of age or older, were premenopausal, and had a history of heavy menstrual bleeding at the time of REA. INTERVENTIONS The intervention under investigation was REA. MEASUREMENTS AND MAIN RESULTS The overall probability of postablation hysterectomy was 22.6%. The probabilities of postablation hysterectomy were 36.1% for women younger than 30 years (n = 128), 28% for women 30 to 34.9 years old (n = 528), 29.6% for women 35 to 39.9 years old (n = 1152), and 17.6% for women 40 years and older (n = 2221). Characteristics associated with REAF included tubal occlusion, cesarean section, dysmenorrhea, and chronic pelvic pain (p <.01) among women younger than 40 years. Leiomyomas accounted for higher failure rates in women 40 years and older (p <.01). CONCLUSION Postablation hysterectomy is more likely to occur in women younger than 40 years. REA can be considered in women aged 30 to 39.9 years old, who have no known REAF risk factors. Women younger than 40 years with REAF risk factors will experience higher rates of hysterectomy. Thus, the decision to proceed with REA should be individualized with careful consideration for the underlying causes of abnormal uterine bleeding, while respecting patient autonomy.
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Affiliation(s)
- Ethan Emslie
- College of Medicine (Drs. Emslie and Berscheid).
| | - Justin Mui
- Department of Obstetrics and Gynecology (Drs. Mui, Sullivan, Buitenhuis, and Rattray), University of Saskatchewan, Regina, Saskatchewan, Canada
| | - M Brad Sullivan
- Department of Obstetrics and Gynecology (Drs. Mui, Sullivan, Buitenhuis, and Rattray), University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Erwin Karreman
- Research Department (Dr. Karreman), Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Deanna Buitenhuis
- Department of Obstetrics and Gynecology (Drs. Mui, Sullivan, Buitenhuis, and Rattray), University of Saskatchewan, Regina, Saskatchewan, Canada
| | | | - Darrien Rattray
- Department of Obstetrics and Gynecology (Drs. Mui, Sullivan, Buitenhuis, and Rattray), University of Saskatchewan, Regina, Saskatchewan, Canada
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Eising HP, Punt MC, Schermer T, Leemans JC, Bongers MY. The ISTH-BAT score and outcomes after endometrial ablation in women with heavy menstrual bleeding. Haemophilia 2023; 29:1573-1579. [PMID: 37758646 DOI: 10.1111/hae.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The International Society on Thrombosis and Haemostasis bleeding assessment tool (ISTH-BAT), is used during the diagnostic workup of bleeding disorders. Data on ISTH-BAT scores in women with heavy menstrual bleeding (HMB) undergoing endometrial ablation (EA) could be essential in optimizing HMB counselling. OBJECTIVE To investigate the postsurgical incidence of amenorrhea, dysmenorrhea, quality of life, re-intervention after EA, and ISTH-BAT score. METHODS This study included women who have undergone EA because of HMB. During a follow-up of 2 to 5 years, ISTH-BAT, pictorial blood assessment chart (PBAC), and Short Form-36 survey (SF-36) were administered. At 10 years of follow-up surgical re-interventions were evaluated. RESULTS Seventy-one women were included of whom 77% (n = 55) had an ISTH-BAT score < 6, versus 23% (n = 16) ISTH-BAT score ≥6 (mean age 46.3 versus 42.3, p = 0.004). In the ISTH-BAT ≥6 group versus < 6 group, amenorrhea occurred in 63% (10/16) versus 82% (45/55) (p = 0.111), dysmenorrhea in 38% (6/16) versus 18% (10/55) (p = 0.111), and surgical re-intervention in 19% (3/16) versus 25% (14/55) (p = 0.582). SF-36 item (Bodily) pain was lower in the ISTH-BAT ≥6 group versus < 6 (median score 58.7 vs. 80.0, p = 0.104). CONCLUSIONS An ISTH-BAT score ≥6 may be related to a lower amenorrhea incidence and higher dysmenorrhea rate after EA.
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Affiliation(s)
- Heleen P Eising
- Department of Gynaecology and Obstetrics, Gelre Hospital, Apeldoorn, The Netherlands
- Grow Research School Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Marieke C Punt
- Department of Gynaecology and Obstetrics, Gelre Hospital, Apeldoorn, The Netherlands
| | - Tjard Schermer
- Gelre Leerhuis, Department of Epidemiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Jaklien C Leemans
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Grow Research School Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
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Cocks RM, Ward MC, Dalton OP, Dalton RV. Time to Hysterectomy After Transcervical Resection of the Endometrium Based on Age: A Retrospective Cohort Review. J Minim Invasive Gynecol 2023; 30:757-761. [PMID: 37220844 DOI: 10.1016/j.jmig.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
STUDY OBJECTIVE To determine the rate of hysterectomy over time after transcervical resection of the endometrium (TCRE) based on age. DESIGN Retrospective audit. SETTING A single gynecology clinic in regional Victoria, Australia. PATIENTS A total of 1078 patients who had undergone TCRE for abnormal uterine bleeding. INTERVENTIONS The likelihood of hysterectomy was compared across age groups using the chi-square test. Time to hysterectomy was summarized as a median with the 25th and 75th percentiles and compared across age groups using the Kaplan-Meier plot (log-rank test) and Cox proportional hazards regression. MEASUREMENTS AND MAIN RESULTS The overall rate of hysterectomy was 24.2% (261 of 1078, 95% confidence interval [CI] 21.7-26.9). When age was categorized into <40 years, 40 to 44 years, 45 to 49 years, and >50 years, the rate of hysterectomy after TCRE was 32.3% (70 of 217), 29.5% (93 of 315), 19.6% (73 of 372), and 14.4% (25 of 174), respectively (p <.001). The likelihood of hysterectomy at any time point after TCRE among those aged 45 to 49 years and older than 50 years was 43% and 59% lower, respectively, than patients under 40 years (hazard ratio, 0.57; 95% CI, 0.41-0.80, and hazard ratio, 0.41; 95% CI, 0.26-0.65, respectively). The median time to hysterectomy was 1.68 years (25th to 75th percentiles, 0.77-3.76). CONCLUSION This study demonstrated that patients who underwent a TCRE before the age of 45 years had a higher chance of having a hysterectomy than patients older than 45 years. This information will enable clinicians to inform patients of their chance of undergoing a hysterectomy at any time after TCRE.
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Affiliation(s)
- Renee M Cocks
- Rural Clinical School (Dr. Cocks), Melbourne Medical School, University of Melbourne, Ballarat, Victoria, Australia; Northern Health (Dr. Cocks), Epping, Victoria, Australia.
| | - Madeleine C Ward
- Obstetrics and Gynecology Ballarat (Dr. Ward and Dr. R. Dalton), Wendouree, Victoria, Australia; Monash University (Dr. Ward), Clayton, Victoria, Australia
| | - Oliver P Dalton
- Ballarat Health Services (Dr. O. Dalton), Ballarat, Victoria, Australia
| | - Russell V Dalton
- Obstetrics and Gynecology Ballarat (Dr. Ward and Dr. R. Dalton), Wendouree, Victoria, Australia
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Oderkerk TJ, Beelen P, Bukkems ALA, Van Kuijk SMJ, Sluijter HMM, van de Kar MRD, Herman MC, Bongers MY, Geomini PMAJ. Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:51-60. [PMID: 37290114 DOI: 10.1097/aog.0000000000005223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/30/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the risk of hysterectomy after nonresectoscopic endometrial ablation in patients with heavy menstrual bleeding. DATA SOURCES The EMBASE, MEDLINE, ClinicalTrials.gov and Cochrane databases were searched for eligible articles from inception until June 13, 2022. We used combinations of search terms for endometrial ablation and hysterectomy. METHODS OF STUDY SELECTION Articles included in the review described the incidence of hysterectomy at a specific point in time after ablation with a minimum follow-up duration of 12 months. TABULATION, INTEGRATION, AND RESULTS The literature search yielded a total of 3,022 hits. A total of 53 studies met our inclusion and exclusion criteria, including six retrospective studies, 24 randomized controlled trials, and 23 prospective studies. A total of 48,071 patients underwent endometrial ablation between 1992 and 2017. Follow-up duration varied between 12 and 120 months. Analyses per follow-up moment showed 4.3% hysterectomy rate at 12 months of follow-up (n=29 studies), 11.1% at 18 months (n=1 study), 8.0% at 24 months (n=11 studies), 10.2% at 36 months (n=12 studies), 7.6% at 48 months (n=2 studies), and 12.4% at 60 months (n=6 studies). Two studies reported a mean hysterectomy rate at 10 years after ablation of 21.3%. Minimal clinically relevant differences in hysterectomy rates were observed among the different study designs. Furthermore, we found no significant differences in hysterectomy rate among the different nonresectoscopic endometrial ablation devices. CONCLUSION The risk of hysterectomy after endometrial ablation seems to increase from 4.3% after 1 year to 12.4% after 5 years. Clinicians can use the results of this review to counsel patients about the 12% risk of hysterectomy 5 years after endometrial ablation. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020156281.
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Affiliation(s)
- Tamara J Oderkerk
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, the Department of Obstetrics and Gynecology, Grow-school of Oncology and Reproduction, Maastricht University, and the Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, the Community Health Service, GGD Noord Brabant, North Brabant, and the Department of Obstetrics and Gynecology, Jeroen Bosch Hospital's-Hertogenbosch, Hertogenbosch, the Netherlands
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Samala M, Pasupula SS, Mudigonda S, Tadikonda RR. Endometrial ablation techniques in treating menorrhagia. Minerva Obstet Gynecol 2023; 75:279-287. [PMID: 35912462 DOI: 10.23736/s2724-606x.22.05101-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Menorrhagia is a frequent gynecological problem that is clinically described as excessive blood loss of 80 mL per menstrual cycle. It has the potential to lower their quality of life and to induce anemia. Medical therapy has typically been the first line of treatment; however, it is frequently ineffectual. Hysterectomy, on the other hand, is clearly 100 percent effective in stopping bleeding, but it is more expensive and can cause serious problems. So, the endometrial ablation is preferred when the endometrial layer is destroyed or removed during the procedure. To "ablate" (remove) the endometrial lining, a variety of procedures has been devised. The gold standard resectoscopic procedures (laser, transcervical endometrial resection, and rollerball) require hysteroscopic visualization of the uterus and while safe, necessitate expert surgeons. Several innovative procedures have lately been developed, the majority of which may be conducted blindly and take less time. Many nonresectoscopic procedures are still in the process of being developed, refined, and investigated. This article discusses the various techniques and procedures used in endometrial ablation, the importance of the physician using endometrial thinning agents because success rates are higher when thinning agents are used, and the importance of women understanding the complications mainly related to pregnancy. Women should be helped to make informed management decisions by discussing the risks and benefits of each treatment with their consultant. Since there are many treatment options available, with no one option being superior in all respects, patient preference and treatment preferences should be considered when deciding on management.
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Oderkerk TJ, Beelen P, Geomini PMAJ, Herman MC, Leemans JC, Duijnhoven RG, Bosmans JE, Pannekoek JN, Clark TJ, Mol BWJ, Bongers MY. Endometrial ablation plus levonorgestrel releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding: study protocol of a multicentre randomised controlled trial; MIRA2 trial. BMC Womens Health 2022; 22:257. [PMID: 35761328 PMCID: PMC9235075 DOI: 10.1186/s12905-022-01843-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background It is estimated that between 12 to 25% of women who undergo an endometrial ablation for heavy menstrual bleeding (HMB) are dissatisfied after two years because of recurrent menstrual bleeding and/or cyclical pelvic pain, with around 15% of these women ultimately having a hysterectomy. The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) immediately after endometrial ablation may inactivate residual untreated endometrium and/or inhibit the regeneration of endometrial tissue. Furthermore, the LNG-IUS may prevent agglutination of the uterine walls preventing intrauterine adhesion formation associated with endometrial ablation. In these ways, insertion of an LNG-IUS immediately after endometrial ablation might prevent subsequent hysterectomies because of persisting uterine bleeding and cyclical pelvic pain or pain that arises de novo. Hence, we evaluate if the combination of endometrial ablation and an LNG-IUS is superior to endometrial ablation alone in terms of reducing subsequent rates of hysterectomy at two years following the initial ablative procedure. Methods/design We perform a multicentre randomised controlled trial in 35 hospitals in the Netherlands. Women with heavy menstrual bleeding, who opt for treatment with endometrial ablation and without contraindication for an LNG-IUS are eligible. After informed consent, participants are randomly allocated to either endometrial ablation plus LNG-IUS or endometrial ablation alone. The primary outcome is the hysterectomy rate at 24 months following endometrial ablation. Secondary outcomes include women’s satisfaction, reinterventions, complications, side effects, menstrual bleeding patterns, quality of life, societal costs. Discussion The results of this study will help clinicians inform women with HMB who opt for treatment with endometrial ablation about whether concomitant use of the LNG-IUS is beneficial for reducing the need for hysterectomy due to ongoing bleeding and/or pain symptoms. Trial registration Dutch Trial registration: NL7817. Registered 20 June 2019, https://www.trialregister.nl/trial/7817. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01843-6.
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Affiliation(s)
- Tamara J Oderkerk
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbox 7777, 5500 MB, Veldhoven, The Netherlands. .,Research School Grow, Maastricht University, Maastricht, The Netherlands.
| | - Pleun Beelen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbox 7777, 5500 MB, Veldhoven, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbox 7777, 5500 MB, Veldhoven, The Netherlands
| | - Malou C Herman
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Jaklien C Leemans
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbox 7777, 5500 MB, Veldhoven, The Netherlands
| | - Ruben G Duijnhoven
- Clinical Trials Unit of the Netherlands Society of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Justine N Pannekoek
- Clinical Trials Unit of the Netherlands Society of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Thomas J Clark
- University Department of Medicine and Obstetrics & Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre Clayton, Melbourne, Australia
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Postbox 7777, 5500 MB, Veldhoven, The Netherlands.,Research School Grow, Maastricht University, Maastricht, The Netherlands
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7
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Dong AC, Sasaki KJ. A Surgical History of Endometrial Ablation: Past, Present and Future Perspectives. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Allan C. Dong
- Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Kirsten J. Sasaki
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
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Paul TD, Readman E, Mooney S. Tubal interruption and subsequent surgery for pain after endometrial ablation: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2021; 61:934-940. [PMID: 34491577 DOI: 10.1111/ajo.13425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endometrial ablation (EA) is an alternative to hysterectomy for abnormal uterine bleeding (AUB), with reduced recovery time and fewer operative risks. However, post-ablation pain may be associated with subsequent surgery, including hysterectomy. It is uncertain what factors affect surgery rates for post-ablation pain, particularly with respect to timing and technique of tubal interruption. AIM To evaluate the relationship between tubal interruption and post-ablation pain and subsequent surgery. MATERIALS AND METHODS We conducted a retrospective cohort study involving 324 patients at a Melbourne tertiary hospital from 2009 to 2020. The primary outcome was subsequent pelvic surgery for pain following EA. RESULTS Pain following EA was reported by 29.7% of patients, with 10.5% of patients undergoing subsequent surgery for pain. Patients with tubal interruption were more likely to undergo subsequent surgery for pain than those with no tubal interruption (odds ratio (OR): 3.49, 95% CI: 1.59-7.66; P = 0.002). Tubal ligation was strongly associated with subsequent surgery for pain (OR: 3.12, 95% CI: 1.48-6.57; P = 0.003). In contrast, those with salpingectomy did not have an increased risk of subsequent surgery for pain, compared to those with no tubal interruption (OR: 1.5; 95% CI 0.32-7.13). Pre-ablation pain (adjusted OR: 2.98, 95% CI: 1.37-6.48; P = 0.006) and previous caesarean section (OR: 2.66; 95% CI: 1.13-6.25; P = 0.025) were also associated with subsequent surgery for pain. CONCLUSION Our results suggest that tubal interruption, pre-ablation pain and previous caesarean section are associated with subsequent surgery for pain. These results can better inform preoperative counselling regarding the risk of subsequent surgery after EA.
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Affiliation(s)
- Tarini D Paul
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Emma Readman
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Samantha Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
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9
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Oderkerk TJ, van de Kar MMA, van der Zanden CHM, Geomini PMAJ, Herman MC, Bongers MY. The combined use of endometrial ablation or resection and levonorgestrel-releasing intrauterine system in women with heavy menstrual bleeding: A systematic review. Acta Obstet Gynecol Scand 2021; 100:1779-1787. [PMID: 34165779 DOI: 10.1111/aogs.14219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/23/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite endometrial ablation/resection being a very successful treatment for women with heavy menstrual bleeding, re-intervention with additional surgery is needed in 12%-25% of cases. Introducing a levonorgestrel-intrauterine system (LNG-IUS) immediately after ablation could preserve the integrity of the uterine cavity and suppress the regenerated or non-ablated endometrial tissue. Therefore, this combined treatment can perhaps lower the re-intervention rate. The aim of this systematic review was to assess the impact of the combined treatment. MATERIAL AND METHODS The MEDLINE, EMBASE, and Cochrane library were systematically searched. No language restrictions were applied. All types of studies were included reporting on the results of endometrial ablation or resection combined with immediate insertion of LNG-IUS for treatment of heavy menstrual bleeding. The primary outcome was the number of hysterectomies after the ablation procedure. Secondary outcomes included re-intervention rates, removals of LNG-IUS, bleeding pattern, patient satisfaction, adverse effects, and complications. Our protocol was registered in PROSPERO, an international prospective register of systematic reviews under registration number CRD42020151384. RESULTS Six studies with a retrospective design and one case series with a follow-up duration varying from 6 to 55 months were included. In total, 427 women were treated with the combined treatment. The studies described a lower hysterectomy and re-intervention rate after combined treatment compared with treatment with endometrial ablation/resection alone. Hysterectomy rate varied from 0% to 11% after combined treatment compared with 9.4% to 24% after endometrial ablation/resection alone. Bleeding patterns and patient satisfaction appeared to be in favor of the combined treatment group. No intra- or post-operative complications or complications in the removal of LNG-IUS were described. The most reported adverse effects after combined treatment were weight gain, mood changes, and headaches. An additional 11 studies with only an abstract available substantiated these findings. All the included studies had poor methodological quality. CONCLUSIONS Based on the available literature, inserting an LNG-IUS immediately after endometrial ablation/resection seems to lower the hysterectomy and re-intervention rates compared with ablation/resection alone. However, as only limited observational studies of low methodological quality are available, high-quality research is necessary to confirm the findings of this systematic review.
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Affiliation(s)
- Tamara J Oderkerk
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands.,Department of Obstetrics and Gynecology, Grow-School of Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Majorie M A van de Kar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | | | - Peggy M A J Geomini
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Malou C Herman
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands.,Department of Obstetrics and Gynecology, Grow-School of Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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Beelen P, van den Brink MJ, Herman MC, Geomini PM, Duijnhoven RG, Bongers MY. Predictive factors for failure of the levonorgestrel releasing intrauterine system in women with heavy menstrual bleeding. BMC WOMENS HEALTH 2021; 21:57. [PMID: 33563257 PMCID: PMC7871623 DOI: 10.1186/s12905-021-01210-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Abstract
Background This study was conducted to identify factors that are associated with failure of treatment using the levonorgestrel releasing intrauterine system (LNG-IUS) in women with heavy menstrual bleeding. Methods For this study, data of a cohort of women treated with an LNG-IUS was used. Women who suffered from heavy menstrual bleeding, aged 34 years and older, without intracavitary pathology and without a future child wish, were recruited in hospitals and general practices in the Netherlands. Eight potential prognostic baseline variables (age, body mass index, caesarean section, vaginal delivery, previous treatment, anticoagulant use, dysmenorrhea, and pictorial blood assessment score) were analyzed using univariable and multivariable regression models to estimate the risk of failure. The main outcome measure was discontinuation of the LNG-IUS within 24 months of follow up, defined as removal of the LNG-IUS or receiving an additional intervention. Results A total of 209 women received the LNG-IUS, 201 women were included in the analyses. 93 women (46%) discontinued LNG-IUS treatment within 24 months. Multivariable analysis showed younger age (age below 45) (adjusted RR 1.51, 95% CI 1.10–2.09, p = .012) and severe dysmenorrhea (adjusted RR 1.36, 95% CI 1.01–1.82, p = .041) to be associated with a higher risk of discontinuation. Conclusions High discontinuation rates are found in women who receive an LNG-IUS to treat heavy menstrual bleeding. A younger age and severe dysmenorrhea are found to be risk factors for discontinuation of LNG-IUS treatment. These results are relevant for counselling women with heavy menstrual bleeding.
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Affiliation(s)
- Pleun Beelen
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB, Veldhoven, The Netherlands. .,Department of General Practice, University of Maastricht, Maastricht, The Netherlands.
| | - Marian J van den Brink
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Malou C Herman
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Peggy M Geomini
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB, Veldhoven, The Netherlands
| | - Ruben G Duijnhoven
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB, Veldhoven, The Netherlands.,Research School Grow, University of Maastricht, Maastricht, The Netherlands
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