Page 37 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

symptoms. One should ascertain whether there are underlying factors that could cause these women to present with complaints of heavy menstrual bleeding. The amount of suffering that women experience from abnormal menstrual bleeding is not only dependent on the severity of the bleeding abnormality itself, but also on the way these women cope with it. Women in a vulnerable position are more likely to have coping difficulties than women in a stable position. Physical examination starts with standard gynaecological examination. In daily practice, imaging tests are widely used in the work-up for women with HMB. The diagnosis of HMB is mostly a combination of one of the following imaging tests: transvaginal ultrasonography (TVS); Saline/gel infusion sonography (SIS/GIS); hysteroscopy; and magnetic resonance imaging (MRI). The first step in imaging tests should be the transvaginal ultrasound. If this is inconclusive or if intracavity abnormalities are suspected, then the physician can perform a saline infusion sonography (SIS) or gel infusion sonography (GIS) to visualise the uterine cavity. Laboratory tests, endometrial sampling, hysteroscopy and MRI should only be performed when indicated.
What is the effectiveness of second-generation ablation techniques at long-term follow-up?
Chapter 3 and 4 focuses on this question.
Chapter 3 presents the 5 year follow-up results of a randomised controlled trial comparing the effectiveness of two second-generation ablation techniques: bipolar radiofrequency impedance controlled endometrial ablation (Novasure®) and hydrothermablation (HTA®). Patients were included between March 2005 and August 2007. One hundred and sixty women with heavy menstrual bleeding were randomly allocated to bipolar ablation or hydrothermablation. At 4–5 years follow- up, a questionnaire was sent to all the participants to register amenorrhea rates, re-interventions, and patient satisfaction. Response rates were 90% in the bipolar group and 83% in the hydrotherm group. Amenorrhea rates were 55.4% and 35.3% in the bipolar group and the hydrotherm group, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.05–2.3). The number of surgical re-interventions was 11 compared with 23 (RR 0.43, 95% CI 0.23–0.80). Overall, more women were satisfied in the bipolar group compared with the hydrotherm group. The results from this study showed that bipolar ablation is more effective than hydrotherm ablation 5 years after treatment.
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Summary
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