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Endometrial destruction techniques for heavy menstrual bleeding using newer global ablation techniques and established hysteroscopic techniques

Lethaby A, Penninx J, Hickey M, Garry R, Marjoribanks J
Published Online: 
30 August 2013

Review question

This review compared the efficacy, safety and acceptability of methods used to destroy the lining of the womb in order to reduce heavy menstrual bleeding in premenopausal women.

Background

Drugs or hysterectomy (removing the womb) used to be the main options for women having problems with heavy menstrual bleeding. In recent decades, surgical techniques have been developed that remove only the lining of the womb (endometrium). These techniques involve either cutting out the endometrium (resection) or destroying it with thermal energy from a laser, electric instruments or other devices (ablation).

Study characteristics

This review identified 25 randomised controlled trials undertaken in 4040 women. Most of the women knew which treatment they were receiving, which may have influenced their judgements about menstrual blood loss and satisfaction. Other aspects of study quality varied among the trials. The evidence was current to June 2013. Eighteen of the 25 trials acknowledged receipt of funding, supply of equipment or technical assistance.

Key results

The review has not found that any of these procedures are better than any other in reducing heavy menstrual bleeding, and satisfaction was high with all procedures. The more modern devices (second-generation ablation) took less time to perform than the older first-generation devices and were more likely to be performed under local anaesthesia when the woman was awake. Side effects were generally similar and mostly mild.

Quality of the evidence

Studies were of low or moderate quality. Few studies were blinded, data were limited, and there was substantial heterogeneity in some outcomes, leading to downgrading of the quality of the evidence.

This record should be cited as: 
Lethaby A, Penninx J, Hickey M, Garry R, Marjoribanks J. Endometrial resection and ablation techniques for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001501. DOI: 10.1002/14651858.CD001501.pub4
Assessed as up to date: 
12 June 2013