NEW YORK (Reuters Health) – Among women treated for heavy menstrual bleeding, those undergoing endometrial ablation are less likely than those having a hysterectomy to need subsequent surgery for pelvic floor repair or urinary incontinence, a Scottish study indicates.

Using population-based data, Dr. S. Bhattacharya with the School of Medicine and Dentistry of the University of Aberdeen, and colleagues examined the risk of further surgery in 51,198 women aged 25–55 years in Scotland who had either an endometrial ablative procedure (n = 14,078) or a hysterectomy (n = 37,120) as a primary surgical treatment for dysfunctional uterine bleeding, over an 18-year period.

As they report in BJOG online May 31, the investigators found that 2779 (19.7%) of the women in the endometrial ablation group went on to have a hysterectomy, while another 962 had repeat ablation or a non-ablative procedure.

However, women who underwent endometrial ablation were less likely than those having a hysterectomy to require pelvic floor repair (hazard ratio 0.62) or tension-free vaginal tape surgery for stress urinary incontinence (HR 0.55), the researchers report.

Furthermore, compared to vaginal hysterectomy, abdominal hysterectomy was associated with a lower likelihood of subsequent pelvic floor repair (HR 0.54), according to the report.

The results may be used to counsel women about surgical options for treating heavy menstrual bleeding, Dr. Bhattacharya and colleagues conclude.

“The lower peri-operative complications of the less invasive ablation procedures need to be balanced against the fact that around one-quarter will require further surgery for the same symptoms” they advise. “The risk of long-term pelvic floor and stress incontinence problems may be less, however.”

Reference:
Outcomes following hysterectomy or endometrial ablation for heavy menstrual bleeding: retrospective analysis of hospital episode statistics in Scotland
BJOG 2011.