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Leyland N, Laberge P, Evans D, Gorak-Savard É, Rittenberg D. Directive clinique n o 453 : Ablation de l'endomètre dans la prise en charge des saignements utérins anormaux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102642. [PMID: 39168284 DOI: 10.1016/j.jogc.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
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Leyland N, Laberge P, Evans D, Savard EG, Rittenberg D. Guideline No. 453: Endometrial Ablation in the Management of Abnormal Uterine Bleeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102641. [PMID: 39168283 DOI: 10.1016/j.jogc.2024.102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
OBJECTIVE To provide an update of the current evidence-based guideline on the techniques and technologies used in endometrial ablation, a minimally invasive technique for the management of abnormal uterine bleeding of benign origin. TARGET POPULATION Women of reproductive age with abnormal uterine bleeding and benign pathology with or without structural abnormalities. BENEFITS, HARMS, AND COSTS Implementation of the guideline recommendations will improve the provision of endometrial ablation as an effective treatment for abnormal uterine bleeding. Following these recommendations would allow the surgical procedure to be performed safely and maximize success for patients. EVIDENCE The guideline was updated with published literature retrieved through searches of Medline and the Cochrane Library from January 2014 to April 2023, using appropriate controlled vocabulary and keywords (endometrial ablation, hysteroscopy, menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding, hysterectomy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English. Grey (unpublished) literature was retrieved from the Association of Obstetricians and Gynecologists of Quebec (AOGQ) in 2023. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Obstetricians, gynaecologists, and primary care providers. SOCIAL MEDIA ABSTRACT This is an updated version of the 2015 SOGC Endometrial Ablation guideline. The authors discuss special considerations, update evidence, and make new fluid deficit recommendations. SUMMARY STATEMENTS RECOMMENDATIONS.
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Cooper N, Papadantonaki R, Yorke S, Khan K. Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review. Facts Views Vis Obgyn 2022; 14:205-218. [DOI: 10.52054/fvvo.14.3.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Heavy menstrual bleeding (HMB) detrimentally effects women. It is important to be able to compare treatments and synthesise data to understand which interventions are most beneficial, however, when there is variation in outcome reporting, this is difficult.
Objectives: To identify variation in reported outcomes in clinical studies of interventions for HMB.
Materials and methods: Searches were performed in medical databases and trial registries, using the terms ‘heavy menstrual bleeding’, menorrhagia*, hypermenorrhoea*, HMB, “heavy period „period“, effective*, therapy*, treatment, intervention, manage* and associated MeSH terms. Two authors independently reviewed and selected citations according to pre-defined selection criteria, including both randomised and observational studies. The following data were extracted- study characteristics, methodology and quality, and all reported outcomes. Analysis considered the frequency of reporting.
Results: There were 14 individual primary outcomes, however reporting was varied, resulting in 45 specific primary outcomes. There were 165 specific secondary outcomes. The most reported outcomes were menstrual blood loss and adverse events.
Conclusions: A core outcome set (COS) would reduce the evident variation in reporting of outcomes in studies of HMB, allowing more complete combination and comparison of study results and preventing reporting bias.
What is new? This in-depth review of past research into heavy menstrual bleeding shows that there is the need for a core outcome set for heavy menstrual bleeding.
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Beelen P, Reinders IMA, Scheepers WFW, Herman MC, Geomini PMAJ, van Kuijk SMJ, Bongers MY. Prognostic Factors for the Failure of Endometrial Ablation: A Systematic Review and Meta-analysis. Obstet Gynecol 2019; 134:1269-1281. [PMID: 31764738 DOI: 10.1097/aog.0000000000003556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an overview of prognostic factors predicting failure of second-generation endometrial ablation. DATA SOURCES MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov were systematically searched from 1988 until February 2019. The search was conducted without language restrictions using the following search terms: "endometrial ablation," "prognosis," "predict," "long term," "late onset," "outcome." METHODS OF STUDY SELECTION The literature search provided a total of 990 studies. All types of studies reporting about prognostic factors of second-generation endometrial ablation failure were included. TABULATION, INTEGRATION, AND RESULTS After screening for eligibility, 56 studies were included in this review, of which 21 were included in the meta-analysis. In these 56 studies, 157,830 women were included. We evaluated 10 prognostic factors: age, myomas, history of tubal ligation, body mass index, parity, preexisting dysmenorrhea, caesarean delivery, bleeding pattern, uterus position, and uterus length. Meta-analysis was performed for the primary outcome (surgical reintervention) to estimate summary treatment effects. Younger age (aged 35 years or younger, odds ratio [OR] 1.68, 95% CI 1.19-2.36; aged 40 years or younger, OR 1.58, 95% CI 1.30-1.93; aged 45 years or younger OR 1.63, 95% CI 1.28-2.07), prior tubal ligation (OR 1.46, 95% CI 1.23-1.73), and preexisting dysmenorrhea (OR 2.12, 95% CI 1.41-3.19) were associated with an increased risk of surgical reintervention. Studies investigating the prognostic factors myomas and obesity showed conflicting results. CONCLUSION Younger age, prior tubal ligation and preexisting dysmenorrhea were found to be associated with failure of endometrial ablation. Obesity and the presence of large submucous myomas may be associated with failure, as well, though more research is necessary to estimate the influence of these factors. It is important to take the results of this review into account when counselling women with heavy menstrual bleeding. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019126247.
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Affiliation(s)
- Pleun Beelen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Departments of Obstetrics and Gynaecology and Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, and the Department of General Practice and the Research School Grow, University of Maastricht, Maastricht, the Netherlands
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Maheux-Lacroix S, Mennen J, Arnold A, Budden A, Nesbitt-Hawes E, Won H, Abbott J. Resolution of Abnormal Uterine Bleeding After Hysteroscopic Morcellation of Endometrial Polyps. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah Maheux-Lacroix
- Department of Obstetrics and Gynecology, CHU de Quebec, Laval University, Quebec, Canada
| | - Jennifer Mennen
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Amy Arnold
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Aaron Budden
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - HaRyun Won
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Jason Abbott
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
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Knuttinen MG, Stark G, Hohenwalter EJ, Bradley LD, Braun AR, Gipson MG, Kim CY, Pinchot JW, Scheidt MJ, Sella DM, Weiss CR, Lorenz JM. ACR Appropriateness Criteria ® Radiologic Management of Uterine Leiomyomas. J Am Coll Radiol 2018; 15:S160-S170. [PMID: 29724419 DOI: 10.1016/j.jacr.2018.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
Abstract
Uterine fibroids, also known as leiomyomas, are the most common benign tumor in women of reproductive age. When symptomatic, these patients can present with bleeding and/or bulk-related symptoms. Treatment options for symptomatic uterine leiomyomas include medical management, minimally invasive treatment such as uterine artery embolization, and surgical options, such as myomectomy. It is important to understand the role of these treatment options in various clinical scenarios so that appropriate consultation is performed. Furthermore, patients should be presented with the outcomes and complications of each of these treatment options. A summary of the data and clinical trials of the treatment options for symptomatic uterine leiomyomas is outlined in this article. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Gregory Stark
- Research Author, University of Illinois at Chicago, Chicago, Illinois
| | - Eric J Hohenwalter
- Panel Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda D Bradley
- Cleveland Clinic, Cleveland, Ohio; American Congress of Obstetricians and Gynecologists
| | - Aaron R Braun
- St. Elizabeth Regional Medical Center, Lincoln, Nebraska
| | | | - Charles Y Kim
- Duke University Medical Center, Durham, North Carolina
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Utility of anesthetic block for endometrial ablation pain: a randomized controlled trial. Am J Obstet Gynecol 2018; 218:225.e1-225.e11. [PMID: 29155035 DOI: 10.1016/j.ajog.2017.11.571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/30/2017] [Accepted: 11/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Second-generation endometrial ablation has been demonstrated safe for abnormal uterine bleeding treatment, in premenopausal women who have completed childbearing, in short-stay surgical centers and in physicians' offices. However, no standard regarding anesthesia exists, and practice varies depending on physician or patient preference and hospital policy and setting. OBJECTIVE The aim of this study was to evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain and associated narcotic use following endometrial ablation. MATERIALS AND METHODS This was a single-center single-blind randomized controlled trial conducted in an academic-affiliated community hospital. A total of 84 English-speaking premenopausal women, aged 30 to 55 years, who were undergoing outpatient endometrial ablation for benign disease were randomized to receive standardized paracervical injection of 20 mL 0.25% bupivacaine (treatment group) or 20 mL normal saline solution (control group) upon completion of ablation. The study was designed to test a 40% 1-hour mean visual analog scale (VAS) pain score difference with an average standard deviation of 75% of both groups' mean VAS scores, using a 2-tailed test, a type I error of 5%, and statistical power of 80%. A sample of 36 patients per study group was required. Assuming a 15% attrition rate, the study enrolled 42 patients per study arm randomized in blocks of 2 (84 total). Two-tailed cross-tabulations with Fisher exact significance values where appropriate and Student t tests were used to compare patient characteristics. Backward stepwise regressions were conducted to control for confounding. RESULTS Between April 2016 and February 2017, a total of 108 women scheduled for endometrial ablation were screened (refusals, n = 21; ineligible, n = 3) to determine whether there were meaningful differences in postoperative VAS pain scores and postoperative narcotic use. Of the 84 randomized women, 2 age-ineligible women were excluded. Intent-to-treat analyses included 1 incorrect randomization (in which the provider consciously decided to provide analgesia regardless of the protocol, after which the provider was excluded from further study participation) and 3 women having no ablation because of operative difficulties. Three were lost to second-day follow-up. Treatment group patients (n = 41) experienced 1.3 points lower 1-hour postoperative VAS pain scores than the control group (n = 41, P = .02). The difference diminished by 4 hours (P = .31) and was negligible by 8 hours (P = .62). Treatment group patients used 3.6 less morphine equivalents of postoperative pain medication (P = .05). Regression analyses controlled for confounding reduced the 1-hour postoperative treatment group pain score difference to 0.8 (confidence interval [CI], -0.6 to 0.1) but slightly increased the average postoperative morphine equivalents to 3.7 (CI, -6.8 to -0.7). CONCLUSION This randomized controlled trial found that local anesthetic with low risk for complications, used in conjunction with general anesthesia, decreased postoperative pain at 1 hour and significantly reduced postoperative narcotic use following endometrial ablation. Further research is needed to determine whether the study results are generalizable and whether post procedure is the best time to administer the paracervical block to decrease endometrial ablation pain.
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Maheux-Lacroix S, Mennen J, Arnold A, Budden A, Nesbitt-Hawes E, Won H, Abbott J. The need for further surgical intervention following primary hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding. Aust N Z J Obstet Gynaecol 2018; 58:570-575. [DOI: 10.1111/ajo.12781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/21/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Sarah Maheux-Lacroix
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Jennifer Mennen
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Amy Arnold
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Aaron Budden
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - HaRyun Won
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Jason Abbott
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
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Endometrial Ablation. J Minim Invasive Gynecol 2017; 25:299-307. [PMID: 28888699 DOI: 10.1016/j.jmig.2017.08.656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022]
Abstract
The destruction of the endometrium in women with heavy menstrual bleeding has been used for well over a century, and the various techniques of delivering forms of thermal energy have been modified over the years to ensure a safe and effective treatment approach. Today, 6 nonresectoscopic devices are approved for use in the United States in addition to resectoscopic techniques that rely on the skillful use of the operative hysteroscope. Regardless of the technique used, endometrial ablation uniformly reduces menstrual blood loss, improves general and menstrual-related quality of life, and prevents hysterectomy in 4 of 5 women who undergo the procedure. When patients are appropriately selected, outcomes are optimized, and risks of serious complications are minimized. This article reviews the literature with singular reference to nonresectoscopic endometrial ablation procedures including historical background, appropriate patient selection, clinical outcomes data, complications, and special or unique considerations.
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Wortman M. Late-onset endometrial ablation failure. Case Rep Womens Health 2017; 15:11-28. [PMID: 29593995 PMCID: PMC5842972 DOI: 10.1016/j.crwh.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022] Open
Abstract
Endometrial ablation, first reported in the 19th century, has gained wide acceptance in the gynecologic community as an important tool for the management of abnormal uterine bleeding when medical management has been unsuccessful or contraindicated. The introduction of global endometrial ablation (GEA) devices beginning in 1997 has provided unsurpassed safety addressing many of the concerns associated with their resectoscopic predecessors. As of this writing the GEA market has surpassed a half-million devices in the United States per annum and has an expected compound annual growth rate (CAGR) projected to be 5.5% from 2016 to 2024. While the short term safety and efficacy of these devices has been reported in numerous clinical trials we only recently are becoming aware of the high incidence of late-onset endometrial ablation failures (LOEAFs) associated with these procedures. Currently, about a quarter of women who undergo a GEA procedure will eventually require a hysterectomy while an unknown number have less than satisfactory results. In order to reduce these suboptimal outcomes physicians must better understand the etiology and risk factors that predispose a patient toward the development of LOEAF as well as current knowledge of patient and procedure selection for EA as well as treatment options for these delayed complications. Over 500,000 endometrial ablations (EAs) are performed in the U. S. each year. Late-onset endometrial ablation failures (LOEAFs) are the most common complication of EA. 25% of women who undergo EA will require hysterectomy within 5 years. Reducing the incidence of LOEAFs requires improved patient selection for EA. Ultrasound-guided reoperative hysteroscopic surgery (UGRHS) reduces the need hysterectomy following LOEAF.
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Affiliation(s)
- Morris Wortman
- Center for Menstrual Disorders, 2020 South Clinton Avenue, Rochester, NY 14618, United States
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Laberge P, Leyland N, Murji A, Fortin C, Martyn P, Vilos G. Ablation de l'endomètre dans la prise en charge des saignements utérins anormaux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S609-S628. [PMID: 28063570 DOI: 10.1016/j.jogc.2016.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reinders IMA, Geomini PMAJ, Timmermans A, de Lange ME, Bongers MY. Local anaesthesia during endometrial ablation: a systematic review. BJOG 2016; 124:190-199. [DOI: 10.1111/1471-0528.14395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- IMA Reinders
- Department of Obstetrics and Gynaecology; Máxima Medical Centre; Veldhoven The Netherlands
| | - PMAJ Geomini
- Department of Obstetrics and Gynaecology; Máxima Medical Centre; Veldhoven The Netherlands
| | - A Timmermans
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| | - ME de Lange
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| | - MY Bongers
- Department of Obstetrics and Gynaecology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht The Netherlands
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Harmon M, Kasbekar AV, Sinha A, Andrews V. Does the working temperature affect the outcome following microwave endometrial ablation? Ir J Med Sci 2016; 186:399-401. [PMID: 27363423 DOI: 10.1007/s11845-016-1475-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Menorrhagia is a common gynaecological complaint, with significant burden to both its sufferers and health service providers. The first line of treatment is usually medical/pharmaceutical although in some cases surgery is required. There are now a number of minimally invasive surgical techniques available that ablate the uterine lining and prevent the need for the removal of the uterus. Microwave endometrial ablation (MEA) is one of these techniques, and this paper investigates the effect of the working temperature on outcome. METHODS A retrospective case note review of women who underwent MEA between June 2000 and August 2004. All women had a hysteroscopy followed by MEA. The duration of the procedure and mean working temperature of the MEA treatment was calculated. Women were followed up 6-8 months after surgery. FINDINGS Two hundred and eleven women underwent the procedure, with an average duration of menorrhagia of 30 months prior to the procedure. Eighty-nine percent attended follow-up, 80 % were satisfied with the procedure and 40 % were amenorrhoeic. When the procedure was performed at higher working temperature within the manufacturers guidelines women were more likely to be amenorrhoeic (78.4 vs. 77.1 °C, p = 0.014). CONCLUSION MEA is more effective in treating menorrhagia when used at a higher operating temperature.
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Affiliation(s)
- M Harmon
- University Hospital Lewisham, London, SE13 6LH, UK
| | - A V Kasbekar
- Aintree University Hospital, Liverpool, L9 7AL, UK
| | - A Sinha
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - V Andrews
- University Hospital Lewisham, London, SE13 6LH, UK.
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Dixit N, Jesner O, Modarres M. Endoscopic Treatment and Power Morcellation of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cooper NAM, Robinson LLL, Clark TJ. Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 41:284-91. [DOI: 10.1136/jfprhc-2014-100872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Laberge P, Leyland N, Murji A, Fortin C, Martyn P, Vilos G, Leyland N, Wolfman W, Allaire C, Awadalla A, Dunn S, Heywood M, Lemyre M, Marcoux V, Potestio F, Rittenberg D, Singh S, Yeung G. Endometrial Ablation in the Management of Abnormal Uterine Bleeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:362-79. [DOI: 10.1016/s1701-2163(15)30288-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, Derrien J, Giraudet G, Kahn V, Koskas M, Legendre G, Lucot JP, Niro J, Panel P, Pelage JP, Fernandez H. Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol 2012; 165:156-64. [PMID: 22939241 DOI: 10.1016/j.ejogrb.2012.07.030] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/26/2012] [Indexed: 11/29/2022]
Abstract
The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids. When pregnancy is desired, whether or not infertility is being treated by assisted reproductive technology, hysteroscopic resection in one or two separate procedures of submucosal fibroids less than 4 cm in length is recommended, regardless of whether they are symptomatic. Interstitial, also known as intramural, fibroids have a negative effect on fertility but treating them does not improve fertility. Myomectomy is therefore indicated only for symptomatic fibroids; depending on their size and number, and may be performed by laparoscopy or laparotomy. Physicians must explain to women the potential consequences of myomas and myomectomy on future pregnancy. For perimenopausal women who have been informed of the alternatives and the risks, hysterectomy is the most effective treatment for symptomatic fibroids and is associated with a high rate of patient satisfaction. When possible, the vaginal or laparoscopic routes should be preferred to laparotomy for hysterectomies for fibroids considered typical on imaging. Because uterine artery embolization is an effective treatment with low long-term morbidity, it is an option for symptomatic fibroids in women who do not want to become pregnant, and a validated alternative to myomectomy and hysterectomy that must be offered to patients. Myolysis is under assessment, and research on its use is recommended. Isolated laparoscopic ligation of the uterine arteries is a potential alternative to uterine artery embolization; it also complements myomectomy by reducing intraoperative bleeding. It is possible to use second-generation techniques of endometrial ablation to treat submucosal fibroids in women whose families are complete. Subtotal hysterectomy is a possible alternative to total hysterectomy for fibroid treatment, given that by laparotomy the former has a lower complication rate than the latter, while by laparoscopy, these rates are the same. In each case, the patient is informed about the benefit and risk associated with each therapeutic option.
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Affiliation(s)
- Henri Marret
- Service de gynécologie, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnelé, 37044 Tours, France.
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AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 2012; 19:152-71. [PMID: 22381967 DOI: 10.1016/j.jmig.2011.09.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/08/2011] [Indexed: 11/21/2022]
Abstract
Submucous leiomyomas or myomas are commonly encountered by gynecologists and specialists in reproductive endocrinology and infertility with patients presenting with 1 or a combination of symptoms that include heavy menstrual bleeding, infertility, and recurrent pregnancy loss. There exists a variety of interventions that include those performed under hysteroscopic, laparoscopic and laparotomic direction; an evolving spectrum of image guided procedures, and an expanding number of pharmaceutical agents, each of which has value for the appropriately selected and counseled patient. Identification of the ideal approach requires the clinician to be intimately familiar with a given patient's history, including her desires with respect to fertility, as well as an appropriately detailed evaluation of the uterus with any one or a combination of a number of imaging techniques, including hysteroscopy. This guideline has been developed following a systematic review of the evidence, to provide guidance to the clinician caring for such patients, and to assist the clinical investigator in determining potential areas of research. Where high level evidence was lacking, but where a majority of opinion or consensus could be reached, the guideline development committee provided consensus recommendations as well.
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Hachmann-Nielsen E, Rudnicki M. Clinical Outcome after Hydrothermal Ablation Treatment of Menorrhagia in Patients with and without Submucous Myomas. J Minim Invasive Gynecol 2012; 19:212-6. [DOI: 10.1016/j.jmig.2011.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/30/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
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Hors fertilité, place de la myomectomie en périménopause et après la ménopause. ACTA ACUST UNITED AC 2011; 40:902-17. [DOI: 10.1016/j.jgyn.2011.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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De Jesus I. Alternatives endocavitaires à la myomectomie dans le traitement des fibromes symptomatiques. ACTA ACUST UNITED AC 2011; 40:937-43. [DOI: 10.1016/j.jgyn.2011.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bipolar Radiofrequency Compared With Thermal Balloon Endometrial Ablation in the Office: A Randomized Controlled Trial. Obstet Gynecol 2011; 117:1228. [DOI: 10.1097/aog.0b013e3182175ba5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bipolar radiofrequency compared with thermal balloon endometrial ablation in the office: a randomized controlled trial. Obstet Gynecol 2011; 117:1227-1228. [PMID: 21508770 DOI: 10.1097/aog.0b013e3182175a7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kopeika J, Edmonds SE, Mehra G, Hefni MA. Does hydrothermal ablation avoid hysterectomy? Long-term follow-up. Am J Obstet Gynecol 2011; 204:207.e1-8. [PMID: 21144493 DOI: 10.1016/j.ajog.2010.10.908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/08/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to assess the long-term success rate of the HydroThermAblator system (HTA). STUDY DESIGN We conducted a retrospective cohort study of 376 patients who underwent HTA at our hospital during an 8-year period, following case note review and distribution of a validated menorrhagia questionnaire. RESULTS The mean age of patients was 43 years. Operative complications included 3 women (0.8%) who experienced intraoperative burns. Of the 248 (66%) returned questionnaires, satisfaction rates were high at 77%. The amenorrhea rate was 38%, with a further 37% of women reporting a substantial decrease in their blood loss. In all, 29 (11%) women underwent subsequent hysterectomy for persistent menorrhagia or dysmenorrhea. Younger women had a significantly higher chance of proceeding to subsequent (P < .05) hysterectomy. CONCLUSION This study confirms the long-term patient satisfaction with HTA and that the overall probability of proceeding to subsequent hysterectomy over 8 years was only 11%.
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Wortman M. Instituting an Office-Based Surgery Program in the Gynecologist’s Office. J Minim Invasive Gynecol 2010; 17:673-83. [DOI: 10.1016/j.jmig.2010.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/14/2010] [Accepted: 07/02/2010] [Indexed: 11/27/2022]
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Wiwanitkit V. Letter to the editor. J Minim Invasive Gynecol 2010; 17:403; author reply 403-4. [PMID: 20417440 DOI: 10.1016/j.jmig.2010.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
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