Commentary on Ten-year follow-up of a randomised controlled trial comparing bipolar endometrial ablation with balloon ablation for menorrhagia

摘要

Second-generation endometrial ablation has superseded hysteroscopic resection and ablation because of improved feasibility, safety and equivalent effectiveness (Daniels et al., BMJ 2012;344:e2564.). However, head-to-head comparisons between technologies are lacking. This randomised controlled trial compared two commonly used ablative techniques. The 1- and 5-year data found amenorrhoea rates to be higher in women treated with radiofrequency ablation (RFA) as opposed to thermal balloon ablation (TBA) (Bongers et al., BJOG 2004; 111:1095-102 and Kleijn et al., BJOG 2008; 115:193-98). However, although amenorrhoea is an easily measured endpoint, its use as a primary outcome is questionable. This is because amenorrhoea is not always desired by women and, indeed, may be detrimental to the patient's psyche. The aim of treatment should be to improve health-related quality of life (HRQL), regardless of whether amenorrhoea results. Furthermore, the mean age of the women was 43 years at inception and therefore, at 10 years, many would be postmenopausal, which is likely to explain the observed increase in amenorrhoea rates over time in both treatment groups and the loss of superiority of RFA over TBA previously observed at 1 and 5 years. There was no significant difference in the amenorrhoea rates (69% versus 67%) when comparing the RFA group with the TBA group at 10 years, whereas the amenorrhoea rates were 41% versus 7%, respectively, at 1 year and 47% versus 30%, respectively, at 5 years.