Short summary

Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common gynaecologic problem. It interferes with daily activities and requently causes anaemia. However, several studies show that up to 27% of women  undergoing TCRE as a primary surgical treatment are referred to hysterectomy within the first 5 years due to continues bleeding.  

The use of the combination of TCRE and Levonorgeastrel intrauterine device (LNG-IUD) has sparsely been investigated. but may lower hysterectomy rate to 0 % compared to 24 % of the patients receiving endometrial ablation alone. 

Rationale

Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common gynaecologic problem, occurring in approximately 10 to 35 per cent of all women. It interferes with daily activities, reduces quality of life and frequently causes anaemia. Currently the first line treatment is progestin-based oral contraceptives, however a recent study found that 58 per cent of women who received medical treatment underwent surgery within the first two years. Surgical treatment of metrorrhagia includes several options. Formerly endometrial resection (Trans Cervical Resection of the Endometrium, TCRE) was the "gold" standard, but later several other ablation techniques appeared. Endometrial resection is less invasive as it preserves the uterus and it is a well-known alternative to hysterectomy. TCRE has fewer and less serious complications than total hysterectomy, thus this appears to be more safe and effective. The most often reported complication is perforation, and secondary hysterectomy due to insufficient results regarding abnormal bleeding pattern or persistent menorrhagia. Thus, several studies show that up to 27% of women  undergoing TCRE are referred to hysterectomy within the first 5 years due to continues bleeding. Hysterectomy, on the other hand is associated with higher complication rate and morbidity.  Data from Danish Hysterectomy database revealed last year a hysterectomy frequency of 28% within the first 5 -years following TCER.

The use of the combination of TCRE and Levonorgeastrel intrauterine device (LNG-IUD) has sparsely been investigated. This combination, on the other hand may increase the rate of amenorrhoea, and thereby decrease the rate of hysterectomy. Recently, two small studies demonstrating that  patients receiving a combination of endometrial ablation and LNG-IUD had significantly lower hysterectomy rate of 0 % as supposed to 24 % of the patients receiving endometrial ablation alone . 

The aim of this study evaluates the efficacy of combining TCER and LNG-IUD

Purpose of the study: 

The purpose of this study is (primary endpoint) 

• The present study is undertaken to describe the rate of hysterectomy in patients treated with TRCE compared to patients treated with TRCE and LNG-IUD

• Secondary endpoint is to describe the rate of amenorrhea patients treated with TRCE compared to patients treated with TRCE and LNG-IUD

Description of the cohort

Women with metrorrhagia referred to endometrial resection.

Data and biological material

Medical record data and questionnaire.