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Comparative Study
. 2009 Nov-Dec;16(6):692-9.
doi: 10.1016/j.jmig.2009.06.022.

Efficacy of bipolar radiofrequency endometrial ablation vs thermal balloon ablation for management of menorrhagia: A population-based cohort

Sherif A El-Nashar  1 , Matthew R Hopkins, Douglas J Creedon, William A Cliby, Abimbola O Famuyide
Affiliations
Comparative Study

Efficacy of bipolar radiofrequency endometrial ablation vs thermal balloon ablation for management of menorrhagia: A population-based cohort

Sherif A El-Nashar et al. J Minim Invasive Gynecol. 2009 Nov-Dec.

Abstract

Study objective: To compare the efficacy of bipolar radiofrequency ablation (RFA) and thermal balloon ablation (TBA) using treatment failure and postprocedure amenorrhea as outcome measures.

Design: Population-based cohort study (Canadian Task Force classification II-2).

Setting: Two medical centers in the upper Midwest.

Patients: Using the medical records linkage system of the Rochester Epidemiology Project, we identified 455 residents of Olmsted County, Minnesota, who underwent global endometrial ablation because of menorrhagia from January 1, 1998, through December 31, 2005. Amenorrhea was defined as complete cessation of menstruation that started immediately after ablation and lasted at least 12 months. Treatment failure was defined as necessity of repeat ablation or hysterectomy because of persistent bleeding or pain. Time to treatment failure for each procedure was compared using Kaplan-Meier plots. Relevant clinical data and complications were abstracted from medical records. Risk adjustments were performed using Cox and logistic regression models.

Interventions: Radiofrequency ablation (n=255) and thermal balloon ablation (n=200).

Measurements and main results: Mean (SD) patient age was 43.3 (5.5) years, and median follow-up was 2.2 years. The 3-year cumulative failure rate was 9% (95% confidence interval [CI], 5%-16%) for RFA and 12% (95% CI, 7%-16%) for TBA (p=.26). The difference remained nonsignificant after adjusting for known predictors of treatment failure such as age, parity, pretreatment dysmenorrhea, and tubal ligation (adjusted HR, 0.7; 95% CI, 0.4-1.4; p=.31). However, women had significantly higher rates of amenorrhea after RFA compared with TBA (32% vs 14%; p <.001). This difference remained significant after adjusting for known predictors of amenorrhea such as age, uterine length, and endometrial thickness (adjusted odds ratio, 2.9; 95% CI, 1.7-4.8; p <.001). Complications were infrequent and similar in the 2 groups.

Conclusion: Both RFA and TBA were equally effective treatments for menorrhagia in a population-based cohort. However, women who underwent RFA were 3 times more likely to have postprocedure amenorrhea.

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Figures

Figure 1
Figure 1
Study Flow Chart. Adapted from El-Nashar et al (21). Used with permission.
Figure 2
Figure 2
Cumulative treatment failure rate after bipolar radiofrequency ablation (RFA) or thermal balloon ablation (TBA). Treatment failure was defined by the performance of re-ablation or hysterectomy.
Figure 3
Figure 3
Secondary treatment outcomes after bipolar radiofrequency ablation (RFA) or thermal balloon ablation (TBA). A, Hemoglobin levels (difference between procedures, P=.19). B, Ferritin levels (difference between procedures, P=.96). TBA and RFA outcomes were compared by assessing the differences in the mean change.
Figure 3
Figure 3
Secondary treatment outcomes after bipolar radiofrequency ablation (RFA) or thermal balloon ablation (TBA). A, Hemoglobin levels (difference between procedures, P=.19). B, Ferritin levels (difference between procedures, P=.96). TBA and RFA outcomes were compared by assessing the differences in the mean change.
See this image and copyright information in PMC

Comment in

  • Letter to the editor.
    Robinson D, Mahmoud R. Robinson D, et al. J Minim Invasive Gynecol. 2010 May-Jun;17(3):401; author reply 401-2. doi: 10.1016/j.jmig.2009.12.009. J Minim Invasive Gynecol. 2010. PMID: 20417438 No abstract available.
  • Letter to the editor.
    Wiwanitkit V. Wiwanitkit V. J Minim Invasive Gynecol. 2010 May-Jun;17(3):403; author reply 403-4. doi: 10.1016/j.jmig.2010.01.004. J Minim Invasive Gynecol. 2010. PMID: 20417440 No abstract available.

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