Several new techniques of endometrial ablation have been developed as alternatives to hysterectomy in the treatment of heavy menstrual loss. Bain and colleagues conducted a prospective randomized controlled trial to compare microwave endometrial ablation with transcervical endometrial resection as treatments of menorrhagia.

They studied women who were referred to a Scottish teaching hospital’s gynecology clinic for treatment of menorrhagia. All patients had a uterine size of 10 weeks equivalent or less and benign endometrial histology within the prior six months. Women were excluded if they were perimenopausal (follicle-stimulating hormone level greater than 30 mIU per mL [30 IU per L]), had adnexal abnormalities, or intended to become pregnant. The 263 participants were randomly assigned to either microwave ablation (129 women) or transcervical endometrial resection (134 women).

All participants completed questionnaires on quality of life and severity of menstrual bleeding and pain before the procedures. This baseline assessment included specific questions on bowel and bladder symptoms to establish any effect from the intervention. All patients received subcutaneous goserelin (3.6 mg) five weeks before the procedure. Two experienced surgeons performed almost all of the ablations. Patients were examined four months after the procedure and surveyed after one and two years. Follow-up was achieved in 95 percent of participants.

The treatment groups were similar in all important respects on entry to the study. Although 90 percent of women in both groups would recommend the procedure to a friend, satisfaction after the microwave procedure was significantly greater than after the transcervical resection (79 percent compared with 67 percent). Compared with women who received transcervical resection, a significantly higher proportion of women who received the microwave procedure reported that it was highly acceptable for menstrual loss (96 percent compared with 88 percent).

At two years, both groups continued to have highly significant reductions in bleeding and pain scores, but there were no significant differences between the groups. Quality-of-life scores were improved after two years, and no excess of bladder or bowel symptoms was detected. No repeat procedures were performed, and the two-year hysterectomy rates were 11.6 percent in the microwave group and 12.7 percent in the transcervical-resection group.

The authors conclude that microwave endometrial ablation is an effective alternative to transcervical endometrial resection for dysfunctional uterine bleeding. It has high patient acceptability and results in sustained improvements for at least two years.