Meta-analysis of bipolar radiofrequency endometrial ablation versus thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding

Abstract

Background: Heavy menstrual bleeding is a common problem that can severely affect quality of life.

Objectives: To compare bipolar radiofrequency endometrial ablation and thermal balloon ablation for heavy menstrual bleeding in terms of efficacy and health-related quality of life (HRQoL).

Search strategy: Online registries were systematically searched using relevant terms without language restriction from inception to November 24, 2016.

Selection criteria: Randomized control trials or cohort studies of women with heavy menstrual bleeding comparing the efficacy of two treatments were eligible.

Data collection and analysis: Data were extracted. Results were expressed as risk ratios (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs).

Main results: Six studies involving 901 patients were included. Amenorrhea rate at 12 months was significantly higher after bipolar radiofrequency endometrial ablation than after thermal balloon ablation (RR 2.73, 95% CI 2.00-3.73). However, no difference at 12 months was noted for dysmenorrhea (RR 1.04, 95% CI 0.68-1.58) or treatment failure (RR 0.78, 95% CI 0.38-1.60). The only significant difference for HRQoL outcomes was for change in SAQ pleasure score (12 months: WMD -3.51, 95% CI -5.42 to -1.60).

Conclusions: Bipolar radiofrequency endometrial ablation and thermal balloon ablation reduce menstrual loss and improve quality of life. However, bipolar radiofrequency endometrial ablation is more effective in terms of amenorrhea rate and SAQ pleasure.

Keywords: Bipolar radiofrequency endometrial ablation; Heavy menstrual bleeding; Meta-analysis; Quality of life; Thermal balloon ablation.