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Am Fam Physician. 2000;62(3):655-656

Endometrial ablation is a well-established treatment of menorrhagia in some women. Most studies report that 60 to 90 percent of patients achieve hypomenorrhea or amenorrhea after the procedure but, to date, the duration of follow up has been limited. Follow-up studies have also predominately used recall and other subjective assessments of menstrual blood flow rather than objective measures. Teirney and colleagues evaluated the volume of menstrual blood loss in women five to six years after rollerball endometrial ablation for menorrhagia.

Women younger than 50 years who had completed their families and had no uterine or cervical pathology were eligible for the study. Those who used hormones or had any medical contraindication to endometrial ablation were excluded from the study. Women who met the study criteria underwent pretreatment with depot goserelin or danazol before undergoing the ablation procedure. Of the 39 women who completed pretreatment and the ablation procedure, 37 were reassessed five to six years after the procedure to measure menstrual blood loss. Measurements were obtained over two cycles from each woman, and mean blood loss was included in the analysis. Blood loss was categorized as hypomenorrhea (up to 7 mL), light (7 to 25 mL), moderate (25 to 60 mL) and heavy (more than 60 mL).

The mean follow-up period was 5.4 years, and mean patient age at follow up was 47.5 years. Of the 37 women contacted at follow up, two had undergone hysterectomy, and nine were postmenopausal. The remaining 26 included 12 women (46 percent) who had persistent amenorrhea since the procedure but were not menopausal as indicated by serum follicle-stimulating hormone (FSH) levels; nine (35 percent) who had hypomenorrhea as defined by study criteria; and five who had light bleeding. None of the women had heavy bleeding following ablation. The mean menstrual blood loss before ablation was 90 (± 14.4) mL compared with 3.3 (± 1.3) mL at follow up. Mean hemoglobin levels in women who were still menstruating at follow up increased significantly, from 126 to 135 g per L.

The authors conclude that patients treated with rollerball ablation can have excellent long-term outcomes, demonstrated by significant decreases in menstrual blood loss and, in a significant proportion of women, complete amenorrhea. In selected patients, these benefits have lasted at least five years.

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