Transcervical resection of endometrium versus medical Rx

There is evidence that in women with heavy menstrual bleeding, transcervical resection of endometrium (TCRE) provides better patient satisfaction and symptom relief than medical treatment.

This evidence is based on a randomised, unblinded, controlled trial with a 2-year follow-up.

• study population was 187 patients who were consulted a consultant for the first time with heavy menstrual bleeding. The patients had a diagnosis of dysfunctional uterine bleeding, had not been referred for surgery, did not wish to have further children and did not have a preference regarding treatment
• 93 woman were allocated to TCRE and 94 to medical management. Medical treatments used consisted of the combined oral contraceptive pill, progestogens, danazol, tranexamic acid, non-steroidal anti-inflammatory drugs and hormone replacement therapy
• the study was analysed by intention to treat. Less women in the TCRE group had heavier or unchanged menstrual bleeding or required additional treatments. Also more women in the TCRE group were cured or had an acceptable improvement in their symptoms (p=0.0017), were satisfied with their treatment (p=0.002) and rated their treatment as acceptable (p=0.004) than the medical management group

Reference:

• Br J Obset Gynaecol (1999), 106, 258-65.