HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Supplement: Appendix Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dickersin, K. Search for Related Content PubMed PubMed Citation Articles by Dickersin, K. Related Collections General gynecology General surgery

Hysterectomy Compared With Endometrial Ablation for Dysfunctional Uterine Bleeding

A Randomized Controlled Trial

From the ¹Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ²David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California; ³Brown Medical School, Providence, Rhode Island; ⁴University of Maryland School of Medicine, Baltimore, Maryland; ⁵Tufts New England Medical Center, Boston, Massachusetts; ⁶Dartmouth Medical School, Hanover, New Hampshire; ⁷Piedmont Reproductive Endocrinology Group, Greenville, South Carolina; ⁸Wake Forest University School of Medicine, Winston-Salem, North Carolina.

OBJECTIVE: To compare the effectiveness of hysterectomy and endometrial ablation in women with dysfunctional uterine bleeding.

METHODS: The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding was a multicenter, randomized controlled trial. Eligible women were premenopausal with dysfunctional uterine bleeding and aged 18 years or older. Primary outcomes were problems that led the woman to seek care solved, bleeding, pain, and fatigue at 12 months. Additional outcomes included quality of life, adverse events, reoperation, and others at 24 months and up to 5 years.

RESULTS: We randomly assigned 237 women between January 1998 and June 2001. Follow-up ended in June 2003. We completed 24 months of follow-up on 114 of 123 women assigned to endometrial ablation and 111 of 114 assigned to hysterectomy. Approximately 85% of women were aged younger than 45 years; 76.4% classified themselves as white, 18.6% as African American, less than 1% as Asian, 4.6% as American Indian, and 8.4% as Hispanic (classification within more than one category possible). Both endometrial ablation and hysterectomy were effective at 24 months in solving the problem that led women to seek care (84.9% compared with 94.4%), and in relieving bleeding, pain, fatigue, and other symptoms, although hysterectomy was more effective for bleeding. By 48 months, 32 of the 110 women initially receiving endometrial ablation required reoperation. Adverse events were more frequent with hysterectomy.

CONCLUSION: Both endometrial ablation and hysterectomy are effective treatments in women with dysfunctional uterine bleeding. Hysterectomy (as the index surgery) was associated with more adverse events and a substantial number of patients receiving endometrial ablation had reoperation.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00114088

LEVEL OF EVIDENCE: I

This article has been cited by other articles:

				A. M. McCausland and V. M. McCausland Hysterectomy Compared With Endometrial Ablation for Dysfunctional Uterine Bleeding: A Randomized Controlled Trial Obstet. Gynecol., April 1, 2008; 111(4): 992 - 992. [Full Text] [PDF]

				K. Dickersin Hysterectomy Compared With Endometrial Ablation for Dysfunctional Uterine Bleeding: A Randomized Controlled Trial Obstet. Gynecol., April 1, 2008; 111(4): 992 - 993. [Full Text] [PDF]

				Abnormal Uterine Bleeding: The Drastic Measure Isn't the Only Solution Journal Watch Women's Health, February 7, 2008; 2008(207): 1 - 1. [Full Text]

				Dysfunctional Uterine Bleeding: Hysterectomy or Endometrial Ablation? Journal Watch (General), January 2, 2008; 2008(102): 8 - 8. [Full Text]