A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years

A Grant, S Bhattacharya, J Mollison, E McIntosh, D R Abramovich, D A Alexander, K Buckingham, S Cunningham, H C Kitchener, D E Parkin, S B Pinion, A Atherton-Naji, I T Russell, I Cameron, Aberdeen Endometrial Ablation Trials Grp

Research output: Contribution to journalArticle

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Abstract

Objective To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy.

Design Long term follow UP Of randomised cohorts of women.

Setting Gynaecology department of a large teaching hospital.

Sample Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously,

Methods Postal questionnaire and case note review. Main outcome measures Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up.

Results Further surgical treatment was received by 39 (38%) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36% and by hysterectomy was 24% (compared with 29% and 14% respectively at one year). Satisfaction rates were high (80% ablation group vs 89% hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (pound 1231 vs pound 1332).

Conclusions While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76% of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.

Original languageEnglish
Pages (from-to)360-366
Number of pages7
JournalBritish Journal of Obstetrics and Gynaecology
Volume106
Publication statusPublished - 1999

Keywords

  • ABDOMINAL HYSTERECTOMY
  • COMPARING HYSTERECTOMY
  • LASER-ABLATION
  • MENORRHAGIA
  • RESECTION
  • SURGERY
  • SCALE

Cite this

A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years. / Grant, A ; Bhattacharya, S ; Mollison, J ; McIntosh, E ; Abramovich, D R ; Alexander, D A ; Buckingham, K ; Cunningham, S ; Kitchener, H C ; Parkin, D E ; Pinion, S B ; Atherton-Naji, A ; Russell, I T ; Cameron, I ; Aberdeen Endometrial Ablation Trials Grp.

In: British Journal of Obstetrics and Gynaecology, Vol. 106, 1999, p. 360-366.

Research output: Contribution to journalArticle

Grant, A, Bhattacharya, S, Mollison, J, McIntosh, E, Abramovich, DR, Alexander, DA, Buckingham, K, Cunningham, S, Kitchener, HC, Parkin, DE, Pinion, SB, Atherton-Naji, A, Russell, IT, Cameron, I & Aberdeen Endometrial Ablation Trials Grp 1999, 'A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years', British Journal of Obstetrics and Gynaecology, vol. 106, pp. 360-366.
Grant, A ; Bhattacharya, S ; Mollison, J ; McIntosh, E ; Abramovich, D R ; Alexander, D A ; Buckingham, K ; Cunningham, S ; Kitchener, H C ; Parkin, D E ; Pinion, S B ; Atherton-Naji, A ; Russell, I T ; Cameron, I ; Aberdeen Endometrial Ablation Trials Grp. / A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years. In: British Journal of Obstetrics and Gynaecology. 1999 ; Vol. 106. pp. 360-366.
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abstract = "Objective To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy.Design Long term follow UP Of randomised cohorts of women.Setting Gynaecology department of a large teaching hospital.Sample Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously,Methods Postal questionnaire and case note review. Main outcome measures Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up.Results Further surgical treatment was received by 39 (38{\%}) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36{\%} and by hysterectomy was 24{\%} (compared with 29{\%} and 14{\%} respectively at one year). Satisfaction rates were high (80{\%} ablation group vs 89{\%} hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93{\%} of that of the hysterectomy group (pound 1231 vs pound 1332).Conclusions While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76{\%} of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.",
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author = "A Grant and S Bhattacharya and J Mollison and E McIntosh and Abramovich, {D R} and Alexander, {D A} and K Buckingham and S Cunningham and Kitchener, {H C} and Parkin, {D E} and Pinion, {S B} and A Atherton-Naji and Russell, {I T} and I Cameron and {Aberdeen Endometrial Ablation Trials Grp}",
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TY - JOUR

T1 - A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years

AU - Grant, A

AU - Bhattacharya, S

AU - Mollison, J

AU - McIntosh, E

AU - Abramovich, D R

AU - Alexander, D A

AU - Buckingham, K

AU - Cunningham, S

AU - Kitchener, H C

AU - Parkin, D E

AU - Pinion, S B

AU - Atherton-Naji, A

AU - Russell, I T

AU - Cameron, I

AU - Aberdeen Endometrial Ablation Trials Grp

PY - 1999

Y1 - 1999

N2 - Objective To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy.Design Long term follow UP Of randomised cohorts of women.Setting Gynaecology department of a large teaching hospital.Sample Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously,Methods Postal questionnaire and case note review. Main outcome measures Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up.Results Further surgical treatment was received by 39 (38%) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36% and by hysterectomy was 24% (compared with 29% and 14% respectively at one year). Satisfaction rates were high (80% ablation group vs 89% hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (pound 1231 vs pound 1332).Conclusions While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76% of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.

AB - Objective To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy.Design Long term follow UP Of randomised cohorts of women.Setting Gynaecology department of a large teaching hospital.Sample Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously,Methods Postal questionnaire and case note review. Main outcome measures Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up.Results Further surgical treatment was received by 39 (38%) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36% and by hysterectomy was 24% (compared with 29% and 14% respectively at one year). Satisfaction rates were high (80% ablation group vs 89% hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (pound 1231 vs pound 1332).Conclusions While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76% of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.

KW - ABDOMINAL HYSTERECTOMY

KW - COMPARING HYSTERECTOMY

KW - LASER-ABLATION

KW - MENORRHAGIA

KW - RESECTION

KW - SURGERY

KW - SCALE

M3 - Article

VL - 106

SP - 360

EP - 366

JO - British Journal of Obstetrics and Gynaecology

JF - British Journal of Obstetrics and Gynaecology

SN - 0306-5456

ER -