Page 13 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

but literature reporting on long-term follow-up is limited. As the aim of ablative therapies is to offer patients a desirable and long-term solution, an adequate follow-up of these therapeutic interventions is still needed.
As mentioned, no evidence-based advice regarding the preferred choice between LNG-IUS or endometrial ablation can be given due to lack of sufficiently powered studies directly comparing both options. In the literature, seven trials compare the LNG-IUS with either transcervical resection of the endometrium or balloon ablation. A significantly lower PBAC score was reported for all women and a significantly lower mean reduction in PBAC score was reported in the surgical group.
Most outcomes showed no difference in satisfaction rates, amenorrhea rates, duration of menstruation, further surgical treatment or quality of life (QoL).30,33- 37 However, these studies are small. Further, most of the studies have a short period of follow-up and contain a lot of non-compliance, which hinders the interpretation of outcomes. Besides, it is not known whether women would accept LNG-IUS side-effects to benefit from a less invasive procedure, or if they would reject hormonal treatment despite the fact that the other option is a more invasive procedure. Nevertheless, many women are keen to avoid hysterectomy and opt for a less invasive treatment, even when they are informed of the fact that success is not always assured.1,27,38,39 Therefore, more research on the effectiveness of these minimally invasive options, and patients’ preferences for them, is needed. The results would contribute to further improvement of patient counselling and therefore would hopefully lead to an increase in patient satisfaction.
All the subjects mentioned in this chapter (diagnosing HMB, evaluating blood loss, effectiveness of different treatments, patient’ s preference) lead to the following question: should HMB be studied using objective assessment with menstrual diaries or subjective assessment such as satisfaction or (disease specific) QoL? On what aspect of HMB should we focus? There is no standardised outcome to define the effect of treatment for HMB and a variety of primary outcomes are currently used. Therefore, it is of utmost importance for the interpretation of data that there is consistency in the choice and definitions in primary and secondary outcomes. Only then can clinicians give their patients well-founded advice.
This thesis deals with the (long-term) effectiveness of endometrial ablation and patient preference for second-generation ablation techniques versus LNG-IUS. Moreover, this thesis provides insight into the outcome measures used in previous HMB research and investigates the value of the PBAC score as an outcome.
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Introduction
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