A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years

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Abstract
Objective To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. Design Long term follow up of randomised cohorts of women. Setting Gynaecology department of a large teaching hospital. Sample Two hundred and four women who had joined a randomised comparison of endornetrial ablation with hysterectomy, 4 to 5.6 years previously. Methods Postal questionnaire and casenote review. Main outcome measures Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up. Results Further surgical treatment was received by 39 (38%) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36% and by hysterectomy was 24% (compared with 29% and 14% respectively at one year). Satisfaction rates were high (80% ablation group vs 89% hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (£1231 vs£1332). Conclusions While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76% of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.