Abnormal Uterine Bleeding: The Drastic Measure Isn’t the Only Solution

Is hysterectomy — one of the most common surgeries among U.S. reproductive-age women — the best approach for managing dysfunctional uterine bleeding? In a randomized, controlled trial sponsored by the Agency for Healthcare Research and Quality, women with excessive or irregular uterine bleeding refractory to medical therapy were assigned to hysterectomy or endometrial ablation (EA). The primary outcome was effectiveness in resolving the foremost problem (typically, excessive bleeding) that led them to seek care. Eligible women did not wish to retain their fertility. Hysterectomy was performed vaginally, laparoscopically, or abdominally. EA was done by resectoscope or thermal balloon.

At 2 years of follow-up, EA had resolved the problem necessitating care in almost 85% of patients (90/106), whereas hysterectomy had resolved the problem in 94% (101/107). Almost one third of women who underwent EA required reoperation for bleeding-related complaints within 4 years. However, adverse events such as thromboembolic and cardiorespiratory events and readmission for surgery were four times more common in the hysterectomy group than in the EA group; postoperative infection was almost six times more common after hysterectomy.