Endometrial resection versus vaginal hysterectomy for menorrhagia: Long-term clinical and quality-of-life outcomes,☆☆,,★★

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Abstract

OBJECTIVE: Our purpose was to compare patients' satisfaction with the effect of treatment, health-related quality of life, psychologic status, and sexual functioning 2 years after endometrial resection or vaginal hysterectomy for menorrhagia. STUDY DESIGN: Menorrhagic women ≤50 years old with a mobile uterus smaller than a 12-week pregnancy were enrolled in a randomized trial to compare endometrial resection and vaginal hysterectomy. Two years after surgery the women were requested to rate the degree of satisfaction with the effect of the operation and to complete the Short Form 36 general health survey questionnaire, the Hospital Anxiety and Depression Scale, and the revised Sabbatsberg Sexual Rating Scale. RESULTS: Forty-one subjects underwent endometrial resection and 44 underwent vaginal hysterectomy without major complications. Of the 77 women attending the 2-year follow-up visit, 33 of 38 (86.8%) in the endometrial resection arm were very satisfied or satisfied with the treatment compared with 37 of 39 (94.8%) of those in the hysterectomy arm. According to the Short Form 36 questionnaire, social functioning and vitality scores were significantly better in the hysterectomy group than in the resection group. Significantly lower Hospital Anxiety and Depression Scale anxiety scores were observed in the former than in the latter subjects. The Sabbatsberg Sexual Rating Scale scores were similar in the two groups. CONCLUSIONS: In patients requiring surgical treatment for menorrhagia vaginal hysterectomy appeared slightly more satisfying and offered a better health-related quality of life than did endometrial resection at 2-year follow-up. Hysterectomy did not adversely affect psychologic status and sexual functioning. (Am J Obstet Gynecol 1997;177:95-101)

Section snippets

Material and methods

This randomized controlled trial compared hysteroscopic endometrial resection with vaginal hysterectomy in the treatment of menorrhagia. The investigation was performed in an academic department specializing in operative hysteroscopy. The trial protocol was approved by the ethics committee of the institution and the subjects gave informed consent to the study.

Women aged ≤50 years referred to a third-level outpatient clinic for menorrhagia not responding to medical treatment and requiring

Results

One hundred eighteen subjects evaluated in a menorrhagia outpatient clinic were considered eligible for the study, but 26 refused randomization. Forty-five of the remaining 92 patients were allocated to endometrial resection and 47 to vaginal hysterectomy. After randomization, 7 women withdrew from the study before surgery, 4 in the endometrial resection group (1 refused the allocated treatment, 1 underwent surgery in another hospital, 1 did not want further treatments, and 1 was lost to

Comment

The results of three randomized clinical trials comparing endometrial resection with hysterectomy have been published.3, 4, 5, 6, 12 In the study of Gannon et al.3 on 51 patients, no significant difference was observed in failure rate between the groups. Four (16%) of the 25 women allocated to operative hysteroscopy had a repeat resection for persistent menorrhagia after a mean follow-up of 12 months. In the Bristol trial4, 6 99 subjects were allocated to endometrial resection and 95 to

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  • Cited by (0)

    From the Clinica Ostetrica e Ginecologica “Luigi Mangiagalli,” Universitá di Milano,a and Laboratorio di Epidemiologia Clinica, Istituto di Richerche Farmacologiche “Mario Negri.”b

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    Supported in part by Italian National Research Council (Rome) Applicazioni Cliniche della Ricerca Oncologica grant No. 94.01322.PF39.

    Reprint requests: Paolo Vercellini, MD, Clinica Ostetrica e Ginecologica “Luigi Mangiagalli,” Universitá di Milano, Via Commenda, 12-20122, Milano, Italy.

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