Two-year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes

Abstract

Objective: To assess clinical status and changes in health related quality of life after two years in women randomised to medical management or transcervical resection of the endometrium (TCRE) for treatment of heavy menstrual loss.

Design: Two-year follow up using postal questionnaires and operative databank review.

Setting: Gynaecology department of a large UK teaching hospital.

Participants: Women who had joined a randomised comparison of medical treatment with TCRE for heavy menstrual loss two years previously.

Main outcome measures: Women's satisfaction with treatment, gynaecological symptoms, changes in health related quality of life, and additional treatments received at two years.

Results: Women allocated medical treatment were significantly less likely to be totally or generally satisfied (57% vs 79%, difference -22%, 95% CI -36, -9%), to find their management acceptable (77% vs 93%, difference -16%, 95% CI -26, -4%), or to recommend their allocated treatment (24% vs 78%, difference -54%, 95% CI -61, -33%). In the medical cohort 59% of women had undergone TCRE, hysterectomy or both, whereas 17% in the TCRE cohort had undergone further surgery. Bleeding and pain scores were similar in the groups and highly significantly better than at recruitment. Short Form-36 health survey scores were significantly improved from baseline for five of the eight health scores in the medical arm, and seven in the TCRE arm.

Conclusions: The results at two years consolidate the findings and conclusions based on the four-month follow up data. A policy of early TCRE is effective and safe and does not result in an increase in hysterectomies. It should not be routinely withheld in an effort to try alternative medical therapies.