Compared with hysterectomy, how effective is endometrial resection/ablation for heavy menstrual bleeding?
All studies were at high risk of performance/detection bias, as it was not feasible to blind women or the surgeon against the type of operation performed. Several older studies were at high risk of selection bias. As the studies used many different measurements for outcomes (particularly for effectiveness of treatment), it was not possible to pool data for every outcome. Only 3 studies included laparoscopic hysterectomy in their comparison.
Heavy menstrual bleeding (HMB), which includes heavy and irregular bleeding, is an important cause of ill health. Surgical treatment of HMB often follows failed or ineffective medical therapy. The definitive treatment is hysterectomy, but this is a major surgical procedure with significant physical and emotional complications, as well as social and economic costs. Several less-invasive surgical techniques (eg, TCRE, laser approaches) and various methods of endometrial ablation have been developed with the aim of improving menstrual symptoms by removing or ablating the entire thickness of the endometrium.