Endometrial ablation techniques in the treatment of dysfunctional uterine bleeding

Dysfunctional uterine bleeding (DUB) is a deviation, from the normal pattern, in the frequency of menstruation or in the duration or amount of bleeding, in the absence of pregnancy, an infection, a tumor or some other organic lesion. Its prevalence is reportedly 20% worldwide and is even higher during adolescence and the decade preceding menopause. Dysfunctional uterine bleeding and menstrual pain (dysmenorrhea) account for one-sixth of the hysterectomies performed in Québec and are the second leading reason for undergoing this procedure. Although hysterectomy is a definitive treatment for these conditions, it is a major surgical procedure with inherent risks and the potential for complications.

This is why endometrial ablation was adopted, toward the end of the 1980s, as a less invasive option and has already undergone different changes aimed at making it easier to perform. This report, which is in response to an assessment request from the ministère de la Santé et des Services sociaux, examines the efficacy, safety and acceptability of the different endometrial ablation techniques, specifying the status, in terms of technological evolution, to which each technique has advanced for broader diffusion. The report also looks at the health-care costs associated with the surgical treatment of dysfunctional uterine bleeding.

Nine techniques were examined. Three of them_transcervical resection of the endometrium, rollerball endometrial ablation and thermal balloon endometrial ablation_are considered accepted; another, endometrial laser intrauterine thermotherapy, is experimental; and ordinary laser ablation is no longer performed in Québec. The other four techniques receive innovative status: microwave endometrial ablation, hydrothermal endometrial ablation, endometrial cryoablation and impedance-controlled endometrial ablation. Innovative techniques should be used only in settings where the clinical outcomes can be evaluated on an ongoing basis and where, if the techniques are diffused more widely, possible training requirements can be determined.