Comparison of Combined Bipolar Radiofrequency Impedance-Controlled Endometrial Ablation with Levonorgestrel Intrauterine System versus Bipolar Radiofrequency Endometrial Ablation Alone in Women with Abnormal Uterine Bleeding

Zhao, Hui; Yang, Bin; Feng, Li; Li, Haixia; Shang, Hongyu; Zhao, Zhanqi; Dai, Yinmei

doi:10.1016/j.jmig.2019.05.022

Cited by 9 publications

(38 citation statements)

References 30 publications

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“…Four retrospective studies with control groups described a hysterectomy rate in the combined treatment group varying between 0% and 11%, whereas treatment with EA alone showed hysterectomy rates varying from 9.4% to 24%. 8,12,14,15 The four studies examining hysteroscopic endometrial resection plus LNG-IUS showed hysterectomy rates of 0%-11%. [12][13][14]17 The remaining four studies investigating non-hysteroscopic EA + LNG-IUS showed 0%-1% hysterectomy rates.…”

Section: Synthesis Of the Resultsmentioning

confidence: 99%

“…[12][13][14]17 The remaining four studies investigating non-hysteroscopic EA + LNG-IUS showed 0%-1% hysterectomy rates. 8,15,16 In two retrospective studies without a control group, a total of two out of 123 women required a hysterectomy after treatment with EA/resection and LNG-IUS, because of ongoing vaginal bleeding. 13,16 In the case series of Bratschi three out of 99 women (3%) required a hysterectomy after the combined treatment, all as the result of (precursors of) cancer.…”

Section: Synthesis Of the Resultsmentioning

confidence: 99%

“…Three studies with control groups showed a lower re-intervention rate in the group of women who received the combined treatment, varying from 0% to 8.7% compared to 19%-29.2% in the EA alone group. 8,14,15 One study without a control group described a 2% reintervention rate. 16 A total of five out of 222 women in the combined treatment group needed further treatment, because of persistent vaginal bleeding (four women) or pelvic pain (one woman).…”

Section: Synthesis Of the Resultsmentioning

confidence: 99%

“…Among the seven included studies were four retrospective cohort studies with a control group, two retrospective studies without a control group and one case series. 8,[12][13][14][15][16][17] All the studies included women with HMB, disregarding one study, which specifically evaluated women with HMB and adenomyosis. 14 A total of 747 women were included with a follow-up duration between 6 and 55.2 months.…”

Section: General Characteristics Of the Studiesmentioning

confidence: 99%

“…It could suppress regeneration of endometrial tissue and suppress non-ablated endometrial tissue and areas of adenomyosis, resulting in a decreased hysterectomy rate. 8 We aim to perform a systematic review, to assess the advantages and/or complications after combined treatment with EA and LNG-IUS in women with HMB.…”

Section: Introductionmentioning

confidence: 99%

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The combined use of endometrial ablation or resection and levonorgestrel‐releasing intrauterine system in women with heavy menstrual bleeding: A systematic review

Oderkerk

Kar

Zanden

et al. 2021

Acta Obstet Gynecol Scand

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Introduction: Despite endometrial ablation/resection being a very successful treatment for women with heavy menstrual bleeding, re-intervention with additional surgery is needed in 12%-25% of cases. Introducing a levonorgestrel-intrauterine system (LNG-IUS) immediately after ablation could preserve the integrity of the uterine cavity and suppress the regenerated or non-ablated endometrial tissue. Therefore, this combined treatment can perhaps lower the re-intervention rate. The aim of this systematic review was to assess the impact of the combined treatment. Material and methods:The MEDLINE, EMBASE, and Cochrane library were systematically searched. No language restrictions were applied. All types of studies were included reporting on the results of endometrial ablation or resection combined with immediate insertion of LNG-IUS for treatment of heavy menstrual bleeding. The primary outcome was the number of hysterectomies after the ablation procedure.Secondary outcomes included re-intervention rates, removals of LNG-IUS, bleeding pattern, patient satisfaction, adverse effects, and complications. Our protocol was registered in PROSPERO, an international prospective register of systematic reviews under registration number CRD42020151384.Results: Six studies with a retrospective design and one case series with a followup duration varying from 6 to 55 months were included. In total, 427 women were treated with the combined treatment. The studies described a lower hysterectomy and re-intervention rate after combined treatment compared with treatment with endometrial ablation/resection alone. Hysterectomy rate varied from 0% to 11% after combined treatment compared with 9.4% to 24% after endometrial ablation/resection alone. Bleeding patterns and patient satisfaction appeared to be in favor of the combined treatment group. No intra-or post-operative complications or complications in the removal of LNG-IUS were described. The most reported adverse effects after combined treatment were weight gain, mood changes, and headaches. An additional S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Oderkerk TJ, van de Kar MMA, van der Zanden CHM, Geomini PMAJ, Herman MC, Bongers MY. The combined use of endometrial ablation or resection and levonorgestrel-releasing intrauterine system in women with heavy menstrual bleeding: A systematic review. Acta Obstet

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