Jul 2, 2013

Endometrial Ablation Effective for Irregular Bleeding

Women with heavy, irregular bleeding can be treated with endometrial ablation as effectively as women whose cycles are heavy but regular, according to new research.

“Most of the literature is on endometrial ablation for heavy bleeding — menorrhagia. Some people counsel their patients away from getting ablation if they have irregular bleeding because there’s no evidence,” Alexis Hokenstad, MD, from the Mayo Clinic in Rochester, Minnesota, told Medscape Medical News.

“But we found that treatment failure was not different, and several people I’ve talked to today have found these results interesting,” Dr. Hokenstad said here at the American Congress of Obstetricians and Gynecologists 61st Annual Clinical Meeting.

“The effectiveness of ablation in women with heavy and irregular bleeding is generally unknown,” said Kristen Matteson, MD, from Women and Infants Hospital in Providence, Rhode Island. Dr. Matteson was not involved in this study, but collaborated with the Mayo researchers on a recent clinical practice guideline for the management of abnormal uterine bleeding (J Minim Invasive Gynecol2012;19:81-88).

“This interesting finding warrants validation in future studies of women with heavy and irregular menstrual bleeding,” Dr. Matteson told Medscape Medical News. “These women have traditionally been excluded from studies of treatments for abnormal uterine bleeding, yet they represent a substantial number of women seeking medical care in the United States.”

In the current analysis, Dr. Hokenstad and her team examined outcomes for 708 women with abnormal bleeding who underwent endometrial radiofrequency or thermal balloon ablation at the Mayo Clinic.

Of those, 253 (35.7%) had irregular bleeding and 455 (64.3%) had regular, heavy bleeding.

Researchers are starting to take a more intensive look at women seeking treatment with heavy and irregular bleeding.

The rate of treatment failure, defined as the need for reablation or hysterectomy within 5 years of the procedure, was not significantly different between those with irregular bleeding and those with regular bleeding (11.9% vs 9.7%; hazard ratio, 1.17; 95% confidence interval, 0.74 – 1.90; P = .519), after adjustment for age at the time of the procedure, body mass index, parity, tubal ligation status, and history of dysmenorrhea.

For amenorrhea, defined as a cessation of menstruation for a minimum of 12 months after ablation, the crude rate was unexpectedly higher in the irregular bleeding group than in the regular bleeding group (22.9% vs 19.1%; P = 0.232), she reported.

However, after adjustment for age at the time of the procedure, endometrial thickness, and uterine length — all known predictors of amenorrhea — the difference was no longer significant (P = 0.917).

“We advise our patients before the procedure not to expect amenorrhea, but for most of them, it reduced their bleeding enough that they were happy and didn’t pursue any further treatment, at least in the first 5 years after the procedure,” said Dr. Hokenstad.

“It is great that researchers are starting to take a more intensive look at women with heavy and irregular bleeding seeking treatment,” said Dr. Matteson, who suggested that the findings are somewhat unexpected.

“For women with irregular bleeding, treatment failure and risk of continued irregular bleeding are always a concern. It is somewhat surprising that this study showed that women with irregular bleeding were not at higher risk for failure than women without irregular bleeding,” she said.

Dr. Matteson emphasized that additional studies are needed to confirm the effectiveness of ablation in this population. “More information is also needed about subsequent issues after ablation, such as continued irregular bleeding necessitating endometrial biopsy to rule out hyperplasia.”

Dr. Hokenstad and Dr. Matteson have disclosed no relevant financial relationships. Coauthor Dr. Famuyide reports receiving an unrestricted study grant from Hologics.

American Congress of Obstetricians and Gynecologists (ACOG) 61st Annual Clinical Meeting: Abstract 22. Presented May 6, 2013.

— Kate Johnson

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