Question: Can failed (i.e. periods still heavy) new generation endometrial ablation procedures (e.g. Menotreat) cause significant new dysmenorrhoea that didn't exist before?
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Answer:
No evidence was found of dysmenorrhoea arising after second generation endometrial ablation procedures.
A Cochrane review of endometrial destruction techniques for heavy menstrual bleeding (1) found that:
“Regarding complications, women undergoing second generation ablation were less likely to have fluid overload, perforation, cervical lacerations and hematometra as a result of their surgery than women undergoing first generation ablation (OR 0.13, 95% CI 0.04 to 0.5; OR 0.21, 95% CI 0.07 to 0.7; OR 0.12, 95% CI 0.05 to 0.3; OR 0.25, 95% CI 0.09 to 0.7, respectively). They were more likely to have nausea and vomiting and uterine cramping (OR 2.3, 95% CI 1.5 to 3.4; OR =1.8, 95% CI 1.1 to 2.9).
There were no significant differences in satisfaction rates between the two groups at one, three and five-years follow up, except for satisfaction two years after ablation in favour of second generation techniques (OR 1.6, 95% CI 1.13 to 2.3).
There were no significant differences for the other outcomes compared: inability to work, amenorrhoea rates, other complication rates and requirement for any additional surgery or hysterectomy.”
(Evidence level 1a)
Reference:
- Lethaby A, Hickey M, Garry R. Endometrial destruction techniques for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD001501. DOI: 10.1002/14651858.CD001501.pub2. Abstract (and full text in some countries). Full text available to Fellows, Members and Trainees.
Search date: March 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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