Endometrial Ablation for Dysfunctional Uterine Bleeding in Low-Resource Settings: A Randomized Controlled Trial

Mohamed A. Ibrahem and Mustafa T. Abdel-Fattah

Background and Objective: Dysfunctional uterine bleeding (DUB) affects nearly half of those women with abnormal uterine bleeding which has a negative impact on patient's health related quality of life (HRQoL). Endometrial ablation used as an alternative to hysterectomy in dysfunctional uterine bleeding. The objective of this study was to compare the efficacy and safety profile of bipolar resectoscopic endometrial ablation (REA) and non-resectoscopic endometrial ablation modalities (NREA) i.e., (thermal ablation by modified Foley's catheter and chemical ablation using TCA. Materials and Methods: This open-label randomized controlled prospective study conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt during the period from May, 2016 to May, 2019. The study included 150 women with refractory DUB which was randomly allocated as follow: Fifty were assigned to bipolar hysteroscope (versapoint), 50 were assigned to thermal group and 50 were assigned to chemical group. The 1ry outcome was operative time, complications and menstrual changes along 6 months follow up. The 2ry outcome was HRQoL and patient satisfaction. Results: There was significant shorter operative time, hospital stay and more rapid return to daily and sexual activity in thermal and chemical group than hysteroscopic group. There was no significant difference between 3 groups as regard complications, menstrual changes, amenorrhea rate and failure rate along the duration of follow up. Conclusion: Both thermal and chemical methods of endometrial ablation were as effective as REA in the management of DUB and had a significant shorter operative time and shorter hospital stay with more rapid return to daily and sexual activity. Chemical endometrial ablation can be performed without general anaesthesia especially for highly risk patients and in low resource settings.

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