Transcervical resection of endometrium in women with menorrhagia.

TLDR

Sixteen women with menorrhagia underwent hysteroscopic transcervical endometrial resection using an unmodified urological resectoscope as an alternative to hysterectomy. The procedure was successful in 15 of 16 patients, with no major complications; follow‑up up to six months showed reduced menstrual duration, blood loss, and pain, with six patients becoming amenorrhoeic after total resection, while hysteroscopy revealed upper‑cavity fibrosis and biopsies detected residual normal endometrium in most cases, suggesting preliminary evidence that transcervical endometrial resection may effectively manage menorrhagia.

Abstract

As an alternative to hysterectomy 16 women with menorrhagia were treated with hysteroscopic transcervical resection of the endometrium with an unmodified urological resectoscope. Twelve patients requested total resection of the endometrial lining with the intention of producing amenorrhoea, and four chose partial resection and hypomenorrhoea. Surgery was completed successfully in 15; the remaining woman, who had an acutely retroflexed uterus, sustained a uterine perforation during insertion of the rigid hysteroscope. There were no important postoperative complications, and 13 patients were discharged from hospital the day after operation. Follow up for up to six months showed beneficial effects on the duration of menses and the subjective assessment of menstrual blood loss and pain in the treated women, six of them becoming amenorrhoeic after total resection. Hysteroscopy at three months in 13 patients showed fibrosis confined to the upper half of the uterine cavity. Endouterine biopsy specimens showed the presence of microscopic deposits of normal endometrium in 10 women. Although these results are preliminary, transcervical resection of the endometrium may have an important role in managing this common complaint.