When women need treatment for heavy menstrual bleeding, endometrial ablation is less likely than hysterectomy to be followed later by pelvic floor repair or surgery for urinary incontinence, a Scottish study indicates.
Using population-based data, Dr. S. Bhattacharya of the University of Aberdeen and colleagues examined the risk of further surgery in more than 51,000 women who had either an endometrial ablative procedure (n = 14,078) or a hysterectomy (n = 37,120) as a primary surgical treatment for dysfunctional uterine bleeding, over an 18-year period.
As they report in BJOG online May 31, 2779 women in the endometrial ablation group (19.7%) went on to have a hysterectomy, while another 962 had repeat ablation or a non-ablative procedure.
But women in the ablation group were less likely to require pelvic floor repair (hazard ratio 0.62) or tension-free vaginal tape surgery for stress urinary incontinence (HR 0.55) compared to women whose primary treatment was hysterectomy.
Results also showed that compared to vaginal hysterectomy, abdominal hysterectomy was associated with a lower likelihood of subsequent pelvic floor repair (HR 0.54).
The findings may be used to counsel women about surgical options for treating heavy menstrual bleeding, Dr. Bhattacharya and colleagues conclude.
“The lower peri-operative complications of the less invasive ablation procedures need to be balanced against the fact that around one-quarter will require further surgery for the same symptoms” they advise. “The risk of long-term pelvic floor and stress incontinence problems may be less, however.”
— Reuters Health Information1