Endometrial ablation for postmenopausal uterine bleeding induced by hormone replacement therapy

Douglas R. Phillips, D R Phillips, Phillips DR
The Journal of the American Association of Gynecologic Laparoscopists · 1995 · vol. 2(4) , pp. 389–393 · doi:10.1016/s1074-3804(05)80058-1 · PMID:9050590 · W1997122775
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This paper investigates the efficacy of endometrial ablation as a treatment for postmenopausal uterine bleeding caused by hormone replacement therapy.

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Abstract

STUDY OBJECTIVE: To determine the effectiveness of transcervical endometrial ablation or endomyometrial resection for treating refractory postmenopausal uterine bleeding induced by hormone replacement therapy (HRT). DESIGN: Prospective observational study. SETTING: Community, teaching, and proprietary hospitals. PATIENTS: Twenty-nine postmenopausal women experiencing troublesome uterine bleeding while taking hormones. INTERVENTIONS: Hormone manipulation, office hysteroscopy or sonohysterography, endometrial curettage, and transcervical endometrial ablation or endomyometrial resection were performed in all 29 patients. MEASUREMENTS AND MAIN RESULTS: Twenty-seven women (93.1%) who continued HRT became amenorrheic within 2 months of surgery. The two who did not have irregular, intermittent spotting, but neither one required or desired further surgical intervention. Five women discontinued HRT from 3 to 53 months postoperatively (mean 12.5 +/- 8.2 mo) because of apprehension about developing breast cancer and for personal reasons. The 24 (82.8%) who continued HRT were observed for as long as 99 months (mean 36.4 +/- 5.5 mo); 22 (91.6%) of them remained amenorrheic. Pathologic examination of tissue specimens revealed atrophic endometrium in 4 patients, adenomyosis in 7, simple hyperplasia in 4, submucous leiomyomas in 11, endometrial polyps in 4, and proliferative endometrium in 1. There were no perioperative complications. CONCLUSION: Endometrial ablation or endomyometrial resection was an effective alternative to discontinuing HRT for these postmenopausal women whose uterine bleeding was unrelieved by modification of their sex steroid regimens.

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Condition tags

endometriosis

MeSH descriptors

Endometrium Estrogen Replacement Therapy Postmenopause Postmenopause Uterine Hemorrhage Aged Aged Ambulatory Surgical Procedures Ambulatory Surgical Procedures Atrophy Atrophy Attitude to Health Attitude to Health Breast Neoplasms Breast Neoplasms Breast Neoplasms Curettage Curettage Endometrial Hyperplasia Endometrial Hyperplasia

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License: CC0 · commercial use OK