A randomised comparison of medical and hysteroscopic management in women consulting a gynaecologist for treatment of heavy menstrual loss

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Abstract
Objectives To compare medical with hysteroscopic management in women referred to a gynaecologist complaining of heavy menstrual loss. Design Single‐centre randomised trial. Setting A teaching hospital in the United Kingdom. Participants One hundred and ninety‐seven women seeking specialist treatment of heavy menstrual loss for the first time and willing to accept either treatment. Interventions 1. Medical treatments not previously used by the women prescribed by experienced gynaecologists in standard doses and timings for a minimum of three cycles (n= 94), and 2. transcervical resection of the endometrium performed under general anaesthesia five weeks after goserelin preparation (n= 93). Main outcome measures Treatment satisfaction and acceptability, relief of symptoms, change in haemoglobin, and improvement in health related quality of life, all after four months. Results Women allocated transcervical resection were more likely to be totally or generally satisfied (76%versus 27%, P < 0.001), to find the treatment acceptable (93%versus 36%, P < 0.001), and willing to have the treatment again (93%versus 31%, P < 0.001). Although pain and bleeding were significantly reduced by medical treatment this was modest in comparison with transcervical resection (P < 0.001). Haemoglobin levels were significantly increased only following transcervical resection. Short form 36 scores were also improved in both arms, although only transcervical resection returned them to normal values. Conclusions Medical treatment was less effective than transcervical resection of the endometrium, irrespective of previous treatment or type of medical management. Early hysteroscopic endometrial surgery should be considered by such woman with the choice made by the woman after a full discussion of the advantages and disadvantages of all the options.

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