Endometrial ablation for postmenopausal uterine bleeding induced by hormone replacement therapy.

STUDY

OBJECTIVE

To determine the effectiveness of transcervical endometrial ablation or endomyometrial resection for treating refractory postmenopausal uterine bleeding induced by hormone replacement therapy (HRT).

DESIGN

Prospective observational study.

SETTING

Community, teaching, and proprietary hospitals.

PATIENTS: Twenty-nine postmenopausal women experiencing troublesome uterine bleeding while taking hormones.

INTERVENTIONS: Hormone manipulation, office hysteroscopy or sonohysterography, endometrial curettage, and transcervical endometrial ablation or endomyometrial resection were performed in all 29 patients.

MEASUREMENTS AND MAIN

RESULTS

Twenty-seven women (93.1%) who continued HRT became amenorrheic within 2 months of surgery. The two who did not have irregular, intermittent spotting, but neither one required or desired further surgical intervention. Five women discontinued HRT from 3 to 53 months postoperatively (mean 12.5 +/- 8.2 mo) because of apprehension about developing breast cancer and for personal reasons. The 24 (82.8%) who continued HRT were observed for as long as 99 months (mean 36.4 +/- 5.5 mo); 22 (91.6%) of them remained amenorrheic. Pathologic examination of tissue specimens revealed atrophic endometrium in 4 patients, adenomyosis in 7, simple hyperplasia in 4, submucous leiomyomas in 11, endometrial polyps in 4, and proliferative endometrium in 1. There were no perioperative complications.

CONCLUSION

Endometrial ablation or endomyometrial resection was an effective alternative to discontinuing HRT for these postmenopausal women whose uterine bleeding was unrelieved by modification of their sex steroid regimens.