Why do women choose endometrial ablation rather than hysterectomy?

Abstract

Objective: To determine why women choose endometrial ablation rather than hysterectomy for the treatment of menorrhagia.

Design: Observational study based on postal questionnaires.

Setting: A university hospital.

Patient(s): One hundred eighty randomly selected patients from a cohort of 658 patients who underwent endometrial ablation for the treatment of menorrhagia during the past 7 years.

Intervention(s): None.

Main outcome measure(s): Patient attitude about endometrial ablation.

Result(s): One hundred six questionnaires (58.9%) were completed satisfactorily. The average postoperative follow-up period was 45.1 months (range, 3-80 months). Eleven women (10.4%) had undergone repeated endometrial ablation and 8 (7.5%) had undergone hysterectomy. More than half the women indicated that they would find endometrial ablation acceptable even if there was no chance of amenorrhea, if the probability of menstruation becoming lighter was > or = 4:10, if the likelihood of menstrual pain decreasing was > or = 3:10, if the chance of requiring repeated endometrial ablation or hysterectomy was < or = 1:4, and if the risk of uterine cancer after surgery was < or = 1:200. The three most important advantages of endometrial ablation over hysterectomy were perceived to be the avoidance of major surgery, the fast return to normal functioning, and the short hospitalization.

Conclusion(s): Most women who choose endometrial ablation rather than hysterectomy as therapy for menorrhagia are prepared to undergo hysteroscopic surgery even if the chance of success is relatively poor.