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Meta-Analysis
. 2019 Jan 22;1(1):CD001501.
doi: 10.1002/14651858.CD001501.pub5.

Endometrial resection and ablation techniques for heavy menstrual bleeding

Magdalena Bofill Rodriguez  1 , Anne Lethaby, Mihaela Grigore, Julie Brown, Martha Hickey, Cindy Farquhar
Affiliations
Meta-Analysis

Endometrial resection and ablation techniques for heavy menstrual bleeding

Magdalena Bofill Rodriguez et al. Cochrane Database Syst Rev. .

Abstract

Background: Heavy menstrual bleeding (HMB) is a significant health problem in premenopausal women; it can reduce their quality of life and can cause social disruption and physical problems such as iron deficiency anaemia. First-line treatment has traditionally consisted of medical therapy (hormonal and non-hormonal), but this is not always successful in reducing menstrual bleeding to acceptable levels. Hysterectomy is a definitive treatment, but it is more costly and carries some risk. Endometrial ablation may be an alternative to hysterectomy that preserves the uterus. Many techniques have been developed to 'ablate' (remove) the lining of the endometrium. First-generation techniques require visualisation of the uterus with a hysteroscope during the procedure; although it is safe, this procedure requires specific technical skills. Newer techniques for endometrial ablation (second- and third-generation techniques) have been developed that are quicker than previous approaches because they do not require hysteroscopic visualisation during the procedure.

Objectives: To compare the efficacy, safety, and acceptability of endometrial destruction techniques to reduce heavy menstrual bleeding (HMB) in premenopausal women.

Search methods: We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, CINAHL, and PsycInfo (from inception to May 2018). We also searched trials registers, other sources of unpublished or grey literature, and reference lists of retrieved studies, and we made contact with experts in the field and with pharmaceutical companies that manufacture ablation devices.

Selection criteria: Randomised controlled trials (RCTs) comparing different endometrial ablation or resection techniques for women reporting HMB without known uterine pathology, other than fibroids outside the uterine cavity and smaller than 3 centimetres, were eligible. Outcomes included improvement in HMB and in quality of life, patient satisfaction, operative outcomes, complications, and the need for further surgery, including hysterectomy.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed trials for risk of bias, and extracted data. We contacted study authors for clarification of methods or for additional data. We assessed adverse events only if they were separately measured in the included trials. We undertook comparisons with individual techniques as well as an overall comparison of first- and second-generation ablation methods.

Main results: We included in this update 28 studies (4287 women) with sample sizes ranging from 20 to 372. Most studies had low risk of bias for randomisation, attrition, and selective reporting. Less than half of these studies had adequate allocation concealment, and most were unblinded. Using GRADE, we determined that the quality of evidence ranged from moderate to very low. We downgraded evidence for risk of bias, imprecision, and inconsistency.Overall comparison of second-generation versus first-generation (i.e. gold standard hysteroscopic ablative) techniques revealed no evidence of differences in amenorrhoea at 1 year and 2 to 5 years' follow-up (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.78 to 1.27; 12 studies; 2145 women; I² = 77%; and RR 1.16, 95% CI 0.78 to 1.72; 672 women; 4 studies; I² = 80%; very low-quality evidence) and showed subjective improvement at 1 year follow-up based on a Pictorial Blood Assessment Chart (PBAC) (< 75 or acceptable improvement) (RR 1.03, 95% CI 0.98 to 1.09; 5 studies; 1282 women; I² = 0%; and RR 1.12, 95% CI 0.97 to 1.28; 236 women; 1 study; low-quality evidence). Study results showed no difference in patient satisfaction between second- and first-generation techniques at 1 year follow-up (RR 1.01, 95% CI 0.98 to 1.04; 11 studies; 1750 women; I² = 36%; low-quality evidence) nor at 2 to 5 years' follow-up (RR 1.02, 95% CI 0.93 to 1.13; 672 women; 4 studies; I² = 81%).Compared with first-generation techniques, second-generation endometrial ablation techniques were associated with shorter operating times (mean difference (MD) -13.52 minutes, 95% CI -16.90 to -10.13; 9 studies; 1822 women; low-quality evidence) and more often were performed under local rather than general anaesthesia (RR 2.8, 95% CI 1.8 to 4.4; 6 studies; 1434 women; low-quality evidence).We are uncertain whether perforation rates differed between second- and first-generation techniques (RR 0.32, 95% CI 0.10 to 1.01; 1885 women; 8 studies; I² = 0%).Trials reported little or no difference between second- and first-generation techniques in requirement for additional surgery (ablation or hysterectomy) at 1 year follow-up (RR 0.72, 95% CI 0.41 to 1.26; 6 studies: 935 women; low-quality evidence). At 5 years, results showed probably little or no difference between groups in the requirement for hysterectomy (RR 0.85, 95% CI 0.59 to 1.22; 4 studies; 758 women; moderate-quality evidence).

Authors' conclusions: Approaches to endometrial ablation have evolved from first-generation techniques to newer second- and third-generation approaches. Current evidence suggests that compared to first-generation techniques (endometrial laser ablation, transcervical resection of the endometrium, rollerball endometrial ablation), second-generation approaches (thermal balloon endometrial ablation, microwave endometrial ablation, hydrothermal ablation, bipolar radiofrequency endometrial ablation, endometrial cryotherapy) are of equivalent efficacy for heavy menstrual bleeding, with comparable rates of amenorrhoea and improvement on the PBAC. Second-generation techniques are associated with shorter operating times and are performed more often under local rather than general anaesthesia. It is uncertain whether perforation rates differed between second- and first-generation techniques. Evidence was insufficient to show which second-generation approaches were superior to others and to reveal the efficacy and safety of third-generation approaches versus first- and second-generation techniques.

PubMed Disclaimer

Conflict of interest statement

MB, AL, CF, MG and JB did not report any conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, outcome: 18.2 Bleeding ‐ amenorrhoea at 12 months (final plot).
5
5
Funnel plot of comparison: 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, outcome: 18.4 Satisfaction rate at 1 year follow‐up (final plot).
1.1
1.1. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 1 Bleeding ‐ blood loss (mL) at 6 months.
1.2
1.2. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 2 Bleeding.
1.3
1.3. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 3 Rate of satisfaction at 12 months (very/moderately).
1.4
1.4. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 4 Duration of operation (minutes).
1.5
1.5. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 5 Operative difficulties.
1.6
1.6. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 6 Good general health.
1.7
1.7. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 7 Improvement in menstrual symptoms.
1.8
1.8. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 8 Complication rate: major complications.
1.9
1.9. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 9 Complication rate: minor complications.
1.10
1.10. Analysis
Comparison 1 Laser ablation (first generation) versus transcervical resection of the endometrium (TCRE) (first generation), Outcome 10 Requirement for further surgical treatment (within 12 months).
2.1
2.1. Analysis
Comparison 2 Vaporising electrode ablation (first generation) versus TCRE (first generation), Outcome 1 Bleeding ‐ amenorrhoea rate at 12 months' follow‐up.
2.2
2.2. Analysis
Comparison 2 Vaporising electrode ablation (first generation) versus TCRE (first generation), Outcome 2 Bleeding ‐ PBAC score at 12 months.
2.3
2.3. Analysis
Comparison 2 Vaporising electrode ablation (first generation) versus TCRE (first generation), Outcome 3 Rate of satisfaction at 12 months (very/moderately).
2.4
2.4. Analysis
Comparison 2 Vaporising electrode ablation (first generation) versus TCRE (first generation), Outcome 4 Duration of operation (minutes).
2.5
2.5. Analysis
Comparison 2 Vaporising electrode ablation (first generation) versus TCRE (first generation), Outcome 5 Operative difficulties.
2.6
2.6. Analysis
Comparison 2 Vaporising electrode ablation (first generation) versus TCRE (first generation), Outcome 6 Complication rate: major complications.
3.1
3.1. Analysis
Comparison 3 Rollerball (first generation) versus TCRE (first generation), Outcome 1 Duration of operation (minutes).
3.2
3.2. Analysis
Comparison 3 Rollerball (first generation) versus TCRE (first generation), Outcome 2 Complication rate: major complications.
3.3
3.3. Analysis
Comparison 3 Rollerball (first generation) versus TCRE (first generation), Outcome 3 Requirement for further surgery.
4.1
4.1. Analysis
Comparison 4 Thermal laser (second generation) versus TCRE (first generation), Outcome 1 Bleeding ‐ amenorrhoea rate.
4.2
4.2. Analysis
Comparison 4 Thermal laser (second generation) versus TCRE (first generation), Outcome 2 Rate of satisfaction.
4.3
4.3. Analysis
Comparison 4 Thermal laser (second generation) versus TCRE (first generation), Outcome 3 Duration of operation.
4.4
4.4. Analysis
Comparison 4 Thermal laser (second generation) versus TCRE (first generation), Outcome 4 Complication rate: major complications.
4.5
4.5. Analysis
Comparison 4 Thermal laser (second generation) versus TCRE (first generation), Outcome 5 Complication rate: minor complications.
4.6
4.6. Analysis
Comparison 4 Thermal laser (second generation) versus TCRE (first generation), Outcome 6 Requirement for further surgery rate (hysterectomy only).
5.1
5.1. Analysis
Comparison 5 Hydrothermal ablation (second generation) versus rollerball (first generation), Outcome 1 Bleeding.
5.2
5.2. Analysis
Comparison 5 Hydrothermal ablation (second generation) versus rollerball (first generation), Outcome 2 Rate of satisfaction.
5.3
5.3. Analysis
Comparison 5 Hydrothermal ablation (second generation) versus rollerball (first generation), Outcome 3 Proportion given local rather than general anaesthesia.
5.4
5.4. Analysis
Comparison 5 Hydrothermal ablation (second generation) versus rollerball (first generation), Outcome 4 Complication rate: major complications.
5.5
5.5. Analysis
Comparison 5 Hydrothermal ablation (second generation) versus rollerball (first generation), Outcome 5 Complication rate: minor complications.
5.6
5.6. Analysis
Comparison 5 Hydrothermal ablation (second generation) versus rollerball (first generation), Outcome 6 Requirement for further surgery.
6.1
6.1. Analysis
Comparison 6 Cryoablation (second generation) versus rollerball (first generation), Outcome 1 Bleeding.
6.2
6.2. Analysis
Comparison 6 Cryoablation (second generation) versus rollerball (first generation), Outcome 2 Rate of satisfaction.
6.3
6.3. Analysis
Comparison 6 Cryoablation (second generation) versus rollerball (first generation), Outcome 3 Proportion given local anaesthesia (%).
6.4
6.4. Analysis
Comparison 6 Cryoablation (second generation) versus rollerball (first generation), Outcome 4 Complication rate: major complications.
6.5
6.5. Analysis
Comparison 6 Cryoablation (second generation) versus rollerball (first generation), Outcome 5 Complication rate: minor complications.
6.6
6.6. Analysis
Comparison 6 Cryoablation (second generation) versus rollerball (first generation), Outcome 6 Requirement for further surgery.
7.1
7.1. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 1 Bleeding ‐ amenorrhoea rate at 1 year follow‐up.
7.2
7.2. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 2 Proportion with successful Rx (PBAC < 75).
7.4
7.4. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 4 Rate of satisfaction with treatment at 1 year.
7.5
7.5. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 5 Duration of operation (minutes).
7.6
7.6. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 6 Procedure abandon.
7.7
7.7. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 7 Proportion given local anaesthesia (%).
7.8
7.8. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 8 Complication rate: major complications.
7.9
7.9. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 9 Complication rate: minor complications.
7.10
7.10. Analysis
Comparison 7 Electrode ablation (second generation) versus TCRE + rollerball (first generation), Outcome 10 Requirement for further surgery at 2 years (hysterectomy).
8.1
8.1. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 1 Bleeding.
8.2
8.2. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 2 Rate of satisfaction.
8.4
8.4. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 4 Operative difficulties.
8.5
8.5. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 5 Proportion given local anaesthesia.
8.7
8.7. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 7 Inability to work (proportion of women).
8.9
8.9. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 9 Improvement in other menstrual symptoms: PMS.
8.10
8.10. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 10 Improvement in other menstrual symptoms.
8.11
8.11. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 11 Reduction in pain score (points).
8.12
8.12. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 12 Postoperative analgesia rate.
8.13
8.13. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 13 Complication rate: major complications.
8.14
8.14. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 14 Complication rate: minor complications.
8.15
8.15. Analysis
Comparison 8 Microwave ablation (second generation) versus TCRE + rollerball (first generation), Outcome 15 Requirement for further surgery.
9.1
9.1. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 1 Bleeding.
9.3
9.3. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 3 Success of treatment (lighter periods and no further surgery).
9.4
9.4. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 4 Success of treatment (menstrual score < 185).
9.5
9.5. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 5 Rate of satisfaction.
9.6
9.6. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 6 Duration of operation (minutes).
9.7
9.7. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 7 Operative difficulties.
9.8
9.8. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 8 Inability to work (proportion of women).
9.9
9.9. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 9 Improvement in other menstrual symptoms.
9.10
9.10. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 10 Complication rate: major complications.
9.11
9.11. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 11 Complication rate: minor complications.
9.12
9.12. Analysis
Comparison 9 Balloon endometrial ablation (second generation) versus rollerball endometrial ablation (first generation), Outcome 12 Requirement for further surgery.
10.1
10.1. Analysis
Comparison 10 Balloon (second generation) versus laser (first generation), Outcome 1 Bleeding.
10.3
10.3. Analysis
Comparison 10 Balloon (second generation) versus laser (first generation), Outcome 3 Rate of satisfaction.
10.4
10.4. Analysis
Comparison 10 Balloon (second generation) versus laser (first generation), Outcome 4 Operative difficulties.
10.5
10.5. Analysis
Comparison 10 Balloon (second generation) versus laser (first generation), Outcome 5 Pain score 4 hours post procedure.
10.6
10.6. Analysis
Comparison 10 Balloon (second generation) versus laser (first generation), Outcome 6 Quality of life.
10.9
10.9. Analysis
Comparison 10 Balloon (second generation) versus laser (first generation), Outcome 9 Requirement for further surgery.
11.1
11.1. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 1 Bleeding.
11.2
11.2. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 2 Rate of satisfaction.
11.3
11.3. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 3 Duration of operation (minutes).
11.5
11.5. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 5 Operative difficulties.
11.6
11.6. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 6 Postoperative pain (continuous data).
11.8
11.8. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 8 Hospital stay (days).
11.10
11.10. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 10 Return to normal activities (days).
11.12
11.12. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 12 Complication rate: major complications.
11.13
11.13. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 13 Complication rate: minor complications.
11.14
11.14. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 14 Complication rate: minor complications (dichotomous).
11.15
11.15. Analysis
Comparison 11 Balloon (second generation) versus TCRE (first generation), Outcome 15 Requirement for further surgery.
12.1
12.1. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 1 Bleeding.
12.3
12.3. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 3 Rate of satisfaction.
12.5
12.5. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 5 Operative difficulties.
12.6
12.6. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 6 Completion of procedure.
12.9
12.9. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 9 Quality of life.
12.10
12.10. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 10 Menorrhagia Outcome Questionnaire.
12.12
12.12. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 12 Improvement in other menstrual symptoms.
12.14
12.14. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 14 Complication rate: major complications.
12.15
12.15. Analysis
Comparison 12 Bipolar radiofrequency (second generation) versus balloon ablation (second generation), Outcome 15 Requirement for further surgery.
13.1
13.1. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 1 Bleeding.
13.3
13.3. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 3 Rate of satisfaction.
13.4
13.4. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 4 Operation time (minutes).
13.5
13.5. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 5 Operative difficulties causing failure.
13.6
13.6. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 6 Proportion choosing local anaesthesia.
13.7
13.7. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 7 Proportion requiring opiate analgesia.
13.8
13.8. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 8 Recovery: proportion requiring overnight stay.
13.9
13.9. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 9 Quality of life scores.
13.10
13.10. Analysis
Comparison 13 Microwave ablation (second generation) versus balloon ablation (second generation), Outcome 10 Requirement for further surgery (hysterectomy).
14.1
14.1. Analysis
Comparison 14 Bipolar radiofrequency (second generation) versus hydrothermal ablation (second generation), Outcome 1 Bleeding.
14.2
14.2. Analysis
Comparison 14 Bipolar radiofrequency (second generation) versus hydrothermal ablation (second generation), Outcome 2 Rate of satisfaction.
14.4
14.4. Analysis
Comparison 14 Bipolar radiofrequency (second generation) versus hydrothermal ablation (second generation), Outcome 4 Improvement in other menstrual symptoms.
14.5
14.5. Analysis
Comparison 14 Bipolar radiofrequency (second generation) versus hydrothermal ablation (second generation), Outcome 5 Complication rate: major complications.
14.6
14.6. Analysis
Comparison 14 Bipolar radiofrequency (second generation) versus hydrothermal ablation (second generation), Outcome 6 Requirement for further surgery.
15.1
15.1. Analysis
Comparison 15 Ablative curettage versus overcurettage, Outcome 1 Bleeding.
15.2
15.2. Analysis
Comparison 15 Ablative curettage versus overcurettage, Outcome 2 Surgery difficulties: failure rate of procedure.
15.3
15.3. Analysis
Comparison 15 Ablative curettage versus overcurettage, Outcome 3 Recovery: hospital stay (days).
15.4
15.4. Analysis
Comparison 15 Ablative curettage versus overcurettage, Outcome 4 Complication rate: major complications.
15.5
15.5. Analysis
Comparison 15 Ablative curettage versus overcurettage, Outcome 5 Complication rate: minor complications.
15.6
15.6. Analysis
Comparison 15 Ablative curettage versus overcurettage, Outcome 6 Requirement for further surgery.
16.1
16.1. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 1 Bleeding.
16.2
16.2. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 2 Bleeding PBAC at 12 months' follow‐up.
16.3
16.3. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 3 Rate of satisfaction.
16.4
16.4. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 4 Duration of treatment (seconds).
16.5
16.5. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 5 Improvement in other menstrual symptoms: dysmenorrhoea.
16.6
16.6. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 6 Complication rate.
16.7
16.7. Analysis
Comparison 16 Microwave ablation (second generation) versus bipolar radiofrequency (second generation), Outcome 7 Requirement for further surgery.
17.1
17.1. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 1 Bleeding.
17.2
17.2. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 2 Rate of satisfaction.
17.3
17.3. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 3 Duration of surgery.
17.4
17.4. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 4 Improvement in other menstrual symptoms: dysmenorrhoea.
17.5
17.5. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 5 Improvement in other menstrual symptoms: PMS at 12 months' follow‐up.
17.6
17.6. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 6 Complication rate: major complications.
17.7
17.7. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 7 Complication rate: minor complications.
17.8
17.8. Analysis
Comparison 17 Bipolar (Minerva) (second generation) versus rollerball ablation (first generation), Outcome 8 Requirement for further surgery.
18.1
18.1. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 1 Bleeding.
18.2
18.2. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 2 Bleeding ‐ amenorrhoea at 12 months' follow‐up (final plot).
18.3
18.3. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 3 Satisfaction rate.
18.4
18.4. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 4 Satisfaction rate at 1 year follow‐up (final plot).
18.5
18.5. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 5 Duration of operation (minutes).
18.6
18.6. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 6 Operative difficulties.
18.7
18.7. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 7 Proportion given local anaesthesia (%).
18.8
18.8. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 8 Inability to work.
18.9
18.9. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 9 Complication rate: major complications.
18.10
18.10. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 10 Complication rate: minor complications.
18.11
18.11. Analysis
Comparison 18 Overall analyses: second‐generation endometrial ablation versus first‐generation endometrial ablation, Outcome 11 Requirement for additional surgery.
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References

References to studies included in this review

Abbott 2003 {published data only}
    1. Abbott J, Hawe J, Hunter D, Garry R. A double‐blind randomized trial comparing the Cavaterm and the Novasure endometrial ablation systems for the treatment of dysfunctional uterine bleeding. Fertility and Sterility 2003;80(1):203‐8. - PubMed
Athanatos 2015 {published data only}
    1. Athanatos D, Pados G, Venetis C, Stamatopoulos P, Rousso D, Tsolakidis D, et al. Novasure impedance control system versus microwave endometrial ablation for the treatment of dysfunctional uterine bleeding: a double‐blind, randomized controlled trial. Clinical and Experimental Obstetrics & Gynecology 2015;42(3):347‐51. [PMID: 26152008] - PubMed
    1. Pados G. Treatment of dysfunctional uterine bleeding with second generation ablation devices: microwaves (MEAA) vs Bipolar Impedance Control System (Novasure). http://clinicaltrials.gov/show/NCT01173965.
Bhattacharya 1997 {published data only}
    1. Bhattacharya S, Cameron IM, Parkin DE, Abramovich DR, Mollison J, Pinion SB, et al. A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia. British Journal of Obstetrics and Gynaecology 1997;104:601‐7. - PubMed
Bongers 2004 {published data only}
    1. Bongers M, Herman M, Josien P, Mol BW. Ten‐year follow‐up of a randomized controlled trial comparing NovaSure and Thermachoice in endometrial ablation for dysfunctional uterine bleeding. Journal of Minimally Invasive Gynecology 2011;18(6 Suppl 1):S127.
    1. Bongers MY, Bourdrez P, Heintz PM, Brolmann HAM, Mol BWJ. Bipolar radio frequency endometrial ablation compared with balloon endometrial ablation in dysfunctional uterine bleeding: impact on patients' health‐related quality of life. Fertility and Sterility 2005;83(3):724‐34. - PubMed
    1. Bongers MY, Bourdrez P, Mol BWJ, Heintz APM, Brolmann HAM. Randomised controlled trial of bipolar radio‐frequency endometrial ablation and balloon endometrial ablation. British Journal of Obstetrics and Gynaecology 2004;111:1095‐102. - PubMed
    1. Herman M, Penninx M, Mol B, Bongers M. Ten‐year follow‐up of a randomised controlled trial comparing bipolar endometrial ablation with balloon ablation for heavy menstrual bleeding. British Journal Obstetrics and Gynaecology 2013;120:966‐970. [DOI: 10.1111/1471-0528.12213] - DOI - PubMed
    1. Kleijn JH, Engels R, Bourdrez P, Mol BWJ, Bongers MY. Five‐year follow up of a randomised controlled trial comparing NovaSure and ThermaChoice endometrial ablation. British Journal of Obstetrics and Gynaecology 2008;115:193‐8. - PubMed
Boujida 2002 {published data only}
    1. Boujida VH, Philipsen T, Pelle J, Joergensen JC. Five‐year follow‐up of endometrial ablation: endometrial coagulation versus endometrial resection. Obstetrics and Gynecology 2002;99:988‐92. - PubMed
    1. Furst SN, Philipsen T, Joergensen JC. Ten‐year follow‐up of endometrial ablation. Acta Obstetricia et Gynecologica 2007;86:334‐8. - PubMed
Brun 2006 {published data only}
    1. Brun J‐L, Raynal J, Burlet G, Galand B, Quereux C, Bernard P. Cavaterm thermal balloon endometrial ablation versus hysteroscopic endometrial resection to treat menorrhagia: the French, multicenter, randomized study. Journal of Minimally Invasive Gynecology 2006;13:424‐30. - PubMed
Clark 2011 {published data only}
    1. Clark TJ, Samuel N, Malick S, Middleton LJ, Daniels J, Gupta JK. Bipolar radiofrequency compared with thermal balloon endometrial ablation in the office. Obstetrics and Gynecology 2011;117:109‐18. - PubMed
Cooper 1999 {published data only}
    1. Bain C, Cooper KG, Parkin DE. Microwave endometrial ablation versus endometrial resection: a randomized controlled trial. Obstetrics and Gynecology 2002;99:983‐7. - PubMed
    1. Cooper KG, Bain C, Lawrie L, Parkin DE. A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of five years. British Journal of Obstetrics and Gynaecology 2005;112:470‐5. - PubMed
    1. Cooper KG, Bain C, Parkin DE. Comparison of microwave endometrial ablation and transcervical resection of the endometrium for treatment of heavy menstrual loss: a randomised trial. Lancet 1999;354:1859‐63. - PubMed
    1. Sambrook AM, Bain C, Parkin DE, Cooper KG. A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of 10 years. British Journal of Obstetrics and Gynaecology 2009;116:1033‐7. - PubMed
Cooper 2002 {published data only}
    1. Cooper J, Gimpelson R, Laberge P, Galen D, Garza‐Leal JG, Scott J, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. Journal of the American Association of Gynecologic Laparoscopists 2002;9(4):418‐28. - PubMed
Cooper 2004 {published data only}
    1. Cooper JM, Anderson TL, Fortin CA, Jack SA, Plentl MB. Microwave endometrial ablation vs rollerball electroablation for menorrhagia: a multicenter randomized trial. Journal of the American Association of Gynecologic Laparoscopists 2004;11(3):394‐403. - PubMed
Corson 2000 {published data only}
    1. Corson SL, Brill AI, Brooks PG, Cooper JM, Indman PD, Liu JH, et al. Interim results of the American Vesta trial of endometrial ablation. Journal of the American Association of Gynecologic Laparoscopists 1999;6(1):45‐9. - PubMed
    1. Corson SL, Brill AI, Brooks PG, Cooper JM, Indman PD, Liu JH, et al. One‐year results of the Vesta system for endometrial ablation. Journal of the American Association of Gynecologic Laparoscopists 2000;7(4):489‐97. - PubMed
Corson 2001 {published data only}
    1. Corson SL. A multicenter evaluation of endometrial ablation by hydrothermablator and rollerball for treatment of menorrhagia. Journal of the American Association of Gynecologic Laparoscopists 2001;8(3):359‐67. - PubMed
    1. Goldrath MH. Evaluation of hydrothermablator and rollerball endometrial ablation for menorrhagia 3 years after treatment. Journal of the American Association of Gynecologic Laparoscopists 2003;10(4):505‐11. - PubMed
    1. Loffer F. A clinical comparison of hydrothermablation (HTA) and rollerball for endometrial ablation to treat menorrhagia: a randomized multicenter clinical trial. XVI FIGO World Congress of Obstetrics & Gynecology. 2000; Vol. Abstract Book 2:95.
Duleba 2003 {published data only}
    1. Duleba AJ, Heppard MC, Soderstrom RM, Townsend DE. A randomized study comparing endometrial cryoablation and rollerball electroablation for treatment of dysfunctional uterine bleeding. Journal of the American Association of Gynecologic Laparoscopists 2003;10(1):17‐26. - PubMed
    1. Townsend DE, Duleba AJ, Wilkes MM, et al. Durability of treatment effects after cryoablation versus rollerball electroablation for abnormal uterine bleeding: two‐year results of a multicenter randomized trial. American Journal of Obstetrics and Gynecology 2003;188:699‐701. - PubMed
Ghazizadeh 2014 {published data only}
    1. Ghazizadeh S, Panahi Z, Ghanbari Z, Tarafdari Menshadi A, Farahmandian T, Javadian P. Comparative efficacy of NovaSure, the levonorgestrel‐releasing intrauterine system, and hysteroscopic endometrial resection in the treatment of menorrhagia: a randomized clinical trial. Journal of Gynecologic Surgery 2014;30(4):215‐8. [DOI: 10.1089/gyn.2012.0041] - DOI
Hawe 2003 {published data only}
    1. Hawe J, Abbott J, Hunter D, Phillips G, Garry R. A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding. British Journal of Obstetrics and Gynaecology 2003;110:350‐7. - PubMed
Laberge 2016 {published data only}
    1. Laberge P, Garza‐Leal J, Fortin C, Basinski C, Thiel J, Leyland N, et al. A prospective, randomized, multi‐center, controlled, international clinical study of the safety and efficacy of the Minerva endometrial ablation system: 6 and 12‐month follow‐up results. Journal of Minimally Invasive Gynecology. 2014. - PubMed
    1. Laberge P, Garza‐Leal J, Fortin C, Grainger D, Johns DA, Adkins RT, et al. A randomized controlled multicenter US Food and Drug Administration trial of the safety and efficacy of the Minerva Endometrial Ablation System: one‐year follow‐up results. Journal of Minimally Invasive Gynecology 2017;24(1):124‐32. [DOI: 10.1016/j.jmig.2016.09.009] - DOI - PubMed
    1. Laberge P, Garza‐Leal J, Fortin C, Thiel J, Johns D, Grainger D, et al. A randomized, controlled, multi‐center trial of the safety and efficacy of the Minerva Endometrial Ablation System: one‐year follow‐up results. Journal of Minimally Invasive Gynecology. 2016; Vol. 23:S1‐S252. - PubMed
McClure 1992 {published data only}
    1. McClure N, Marners M, Healy DL, Hill DJ, Lawrence AS, Wingfield M, et al. A quantitative assessment of endometrial electrocautery in the management of menorrhagia and a comparative report of argon laser endometrial ablation. Gynaecological Endoscopy 1992;1:199‐202.
Meyer 1998 {published data only}
    1. Grainger DA, Tjaden DO, Rowland C, Meyer WR. Thermal balloon and rollerball ablation to treat menorrhagia: two‐year results of a multicenter, prospective, randomized clinical trial. Journal of the American Association of Gynecologic Laparoscopists 2000;7(2):175‐9. - PubMed
    1. Loffer FD. Five year post‐procedure follow‐up of patients participating in a randomised trial of uterine balloon therapy vs rollerball ablation for the treatment of menorrhagia. Journal of the American Association of Gynecologic Laparoscopy 2001;8(1):48‐54.
    1. Loffer FD. Three‐year comparison of thermal balloon and rollerball ablation in treatment of menorrhagia. Journal of the American Association of Gynecologic Laparoscopists 2001;8(1):48‐54. - PubMed
    1. Meyer WR, Walsh BW, Grainger DA, Peacock LM, Loffer FD, Steege JF. Thermal balloon and rollerball ablation to treat menorrhagia: a multicenter comparison. Obstetrics and Gynecology 1998;92:98‐103. - PubMed
Onoglu 2007 {published data only}
    1. Onoglu A, Taskin O, Inal M, Sadik S, Simsek M, Akar M, et al. Comparison of the long‐term histopathologic and morphologic changes after endometrial rollerball ablation and resection: a prospective randomized trial. Journal of Minimally Invasive Gynecology 2007;14:39‐42. - PubMed
Pellicano 2002 {published data only}
    1. Pellicano M, Guida M, Acunzo G, Cirillo D, Bifulco G, Nappi C. Hysteroscopic transcervical endometrial resection versus thermal destruction for menorrhagia: a prospective randomized trial on satisfaction rate. American Journal of Obstetrics and Gynecology 2002;187:545‐50. - PubMed
Penninx 2010 {published data only}
    1. Bongers M, Herman M, Penninx J, Mol BW. Longterm follow‐up of a randomized controlled trial comparing NovaSure and hydrothermablation for dysfunctional uterine bleeding. Journal of Minimally Invasive Gynecology 2011;18(6 Suppl 1):S34.
    1. Penninx JPM, Herman MC, Mol BW, Bongers MY. Five‐year follow‐up after comparing bipolar endometrial ablation with hydrothermablation for menorrhagia. Obstetrics and Gynecology 2011;118:1287‐92. - PubMed
    1. Penninx JPM, Mol BW, Engels R, Rumste MME, Kleijn C, Koks CAM, et al. Bipolar radiofrequency endometrial ablation compared with hydrothermablation for dysfunctional uterine bleeding. Obstetrics and Gynecology 2010;116:819‐26. - PubMed
Penninx 2016 {published data only}
    1. Penninx J, Bongers M. Bipolar radiofrequency endometrial ablation versus thermablate balloon ablation for dysfunctional bleeding in the outpatient clinic: a randomized controlled trial. www.controlled‐trials.com/ISRCTN17974690.
    1. Penninx J, Herman M, Kruitwagen R, Ter Haar A, Mol B, Bongers M. Bipolar versus balloon endometrial ablation in the office: a randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016;196:52‐6. [DOI: 10.1016/j.ejogrb.2015.10.010] - DOI - PubMed
    1. Penninx J, Herman M, Mol B, Kruitwagen R, Bongers M. Bipolar radiofrequency endometrial ablation versus Thermablate balloon ablation for dysfunctional bleeding in the outpatient clinic: a randomized controlled trial. Journal of Minimally Invasive Gynecology 2012;19(6):S21‐S22. [DOI: 10.1016/j.jmig.2012.08.076] - DOI
    1. Penninx JPM, Herman MC, Mol BW, Bongers MY. Bipolar radiofrequency endometrial ablation versus thermablate balloon ablation for dysfunctional bleeding in the outpatient clinic: a randomized controlled trial. Journal of Minimally Invasive Gynecology 2012;19(6 Suppl 1):S21‐2.
Perino 2004 {published data only}
    1. Perino A, Castelli A, Cucinella G, Biondo A, Pane A, Venezia R. A randomized comparison of endometrial laser intrauterine thermotherapy and hysteroscopic endometrial resection. Fertility and Sterility 2004;82:731‐4. - PubMed
Romer 1998 {published data only}
    1. Romer T. The treatment of recurrent menorrhagias ‐ Cavaterm‐balloon‐coagulation versus Rollerball‐endometrial ablation ‐ a prospective randomized comparative study [Die therapie rezidivierender Menorrhagien ‐ Cavaterm‐Ballon‐Koagulatioon versus Roller‐Ball‐Endometriumkoagulation ‐ eine prospektive randomisierte Vergleichsstudie]. Zentralblatt fur Gynakologie 1998;120(10):511‐4. - PubMed
Sambrook 2009 {published data only}
    1. Sambrook A, Elders A, Cooper K. Microwave endometrial ablation versus thermal balloon endometrial ablation (MEATBall): 5‐year follow up of a randomised controlled trial. British Journal of Obstetrics and Gynaecology 2014;121:748‐54. [DOI: 10.1111/1471-0528.12585] - DOI - PubMed
    1. Sambrook AM, Cooper KG, Campbell MK, Cook JA. Clinical outcomes from a randomised comparison of microwave endometrial ablation with thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding. British Journal of Obstetrics and Gynaecology 2009;116:1038‐45. - PubMed
Thabet 2010 {published data only}
    1. Thabet SMA. New attempt using ablative curettage technique for managing benign premenopausal uterine bleeding. Obstetrics and Gynaecology Research 2010;36(4):803‐9. - PubMed
van Zon‐Rabelink 2003 {published data only}
    1. Zon‐Rabelink IAA, Vleugels MPH. Treating menorrhagia with endometrial ablation: rollerball electrocoagulation versus thermal ablation with the uterine balloon. Gynaecological Endoscopy Abstract from the 6th Annual Congress of the European Society for Gynaecological Endoscopy 1997;6 Suppl 2:41.
    1. Zon‐Rabelink IAA, Vleugels MPH, Merkus HMWM, Graaf R. Efficacy and satisfaction rate comparing endometrial ablation by rollerball electrocoagulation to uterine balloon thermal ablation in a randomised controlled trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2004;114(1):97‐103. - PubMed
    1. Zon‐Rabelink IAA, Vleugels MPH, Merkus HMWM, Graaf R. Endometrial ablation by rollerball electrocoagulation compared to uterine balloon thermal ablation. Technical and safety aspects. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2003;110:220‐3. - PubMed
Vercellini 1999 {published data only}
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References to studies excluded from this review

Abd Ek Hameed 2012 {published data only}
    1. Abd Ek Hammeed AA. Endometrial thermal balloon ablation by a simple technique using Foley’s catheter with or without pre ablation endometrial curettage to treat cases with intractable menorrhagia. Middle East Fertility Society Journal 2012;17(2):116‐21.
Cash 2012 {published data only}
    1. Cash C, Garza‐Leal J, Donovan A, Guidry C, Romanowski C, Patel B. Clinical evaluation of long‐term safety and effectiveness of a third‐generation thermal uterine balloon therapy system for heavy menstrual bleeding. Journal of Minimally Invasive Gynecology 2012;19(4):469‐76. - PubMed
Chang 2009 {published data only}
    1. Chang P, Vilos G, Abu‐Rafea B, Hollett‐Caines J, Abyaneh Z, Edris F. Comparison of clinical outcomes with low‐voltage (cut) versus high‐voltage (coag) waveforms during hysteroscopic endometrial ablation with the rollerball: a pilot study. Journal of Minimally Invasive Gynecology 2009;1:350‐4. - PubMed
Cooper 2012 {unpublished data only}
    1. Cooper K. Blind versus visual endometrial ablation: a randomised controlled trial. http://www.controlled‐trials.com/mrct/trial/2292665/. [this trial did not take place due to lack of funding]
El‐Nashar 2009 {published data only}
    1. El‐Nashar SA, Hopkins MR, Creedon DJ, Cliby WA, Famuyide AO. Efficacy of bipolar radiofrequency endometrial ablation vs thermal balloon ablation for management of menorrhagia: a population‐based cohort. Journal of Minimally Invasive Gynecology 2009;16:692‐9. - PMC - PubMed
Feng 2006 {published data only}
    1. Feng LM, Gao WL. Clinical analysis of abnormal uterine bleeding treatment with Thermablate EAS. Beijing da Xue Xue Bao 2006;38(4):432‐5. - PubMed
Shokeir 2013 {published data only}
    1. Shokeir T, Eid M, Abdel‐Hady ES. Does adjuvant long‐acting gestagen therapy improve the outcome of hysteroscopic endometrial resection in women of low‐resource settings with heavy menstrual bleeding?. Journal of Minimally Invasive Gynecology 2013;201(2):222‐6. - PubMed
Soysal 2001 {published data only}
    1. Soysal ME, Soysal SK, Vicdan K. Thermal balloon ablation in myoma‐induced menorrhagia under local anaesthesia. Gynecologic and Obstetric Investigation 2001;51:128‐33. - PubMed
Vihko 2003 {published data only}
    1. Vihko KK, Raitala R, Taina E. Endometrial thermoablation for treatment of menorrhagia: comparison of two methods in outpatient setting. Acta Obstetricia et Gynecologica Scandinavian 2003;82:269‐74. - PubMed

References to studies awaiting assessment

Feng 2014 {published data only}
    1. Feng L, Zhang Z, Yang Q, Chen Q. Preliminary results of a randomized controlled trial of the Cardea GEA System versus transcervical resection of the endometrium (TCRE) combined with roller‐ball ablation for the treatment of abnormal uterine bleeding. Journal of Minimally Invasive Gynecology 2014;21:S139.
Hamza 2005 {published data only}
    1. Hamza A, Ismail MT, Abu Shady Y, Hawas NG. Resection versus coagulation techniques of ablation in the management of dysfunctional uterine bleeding. Royal College of Obstetricians and Gynaecologists 6th International Scientific Meeting, Cairo Egypt. 27‐30 September 2005.
NCT00549159 {unpublished data only}
    1. Yu Y, Liu N. Multicenter randomized clinical trial to evaluate the safety and effectiveness of Cavaterm TM thermal balloon endometrial ablation in women with dysfunctional uterine bleeding compared to transcervical resection of the endometrium (TCRE). http://clinicaltrials.gov/show/NCT00549159 accessed May 2018.

References to ongoing studies

NCT02642926 {published data only}
    1. Nazac A. Comparison of the efficiency of bipolar energy versus monopolar energy in endometrial ablation in women having menorrhagia. Clinicaltrials.gov accessed May 2018. [https://clinicaltrials.gov/ct2/show/NCT02642926]

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