Hysterectomy after Transcervical Endometrial Resection in Women with Menorrhagia: A retrospective quality assessment study between 2011 and 2020

Abstract

Background: Menorrhagia can be treated conservatively with progestins or women can choose between transcervical endometrial resection (TCER) or ablation, or hysterectomy. TCER is a uterus-sparing option of removing the uterine endometrial lining to stop menstrual bleeding.<p> <p>Aim: To determine factors associated with requiring hysterectomy after TCER in women with menorrhagia at Helgelandssykehuset Sandnessjøen (SSJ) and Nordland Hospital (NLSH), Bodø, in Northern-Norway. <p> <p>Method: A total of 469 women were included from SSJ and NLSH after a search in medical records based on surgical procedure codes from January 2011 to December 2020. The information collected included the bleeding symptoms, hormonal treatment pre-TCER, surgical procedures, patient satisfaction, bleeding complaints/intensity, pain post-TCER, and characteristics of hysterectomy. T-test and chi-square test were used for statistical analyses. <p> <p>Results: Of 469 women, 124 women (26.4%) had a hysterectomy and 345 women (73.6%) avoided hysterectomy after TCER. The hysterectomy-rate was 32.9% at SSJ and 23.5% at NLSH. There were twice as many surgeons performing TCER at SSJ than NLSH, and the loop electrode was used in about half of the TCER at SSJ and nearly all at NLSH. A larger proportion of cases than controls reported no improvement, persistent bleeding complaints, heavy bleeding, pelvic pain, and dysmenorrhoea after TCER. A larger proportion of women still had bleeding complaints and heavy bleeding, while a smaller proportion had pelvic pain, at SSJ compared to NLSH. The main indications for hysterectomy after TCER included dysmenorrhoea, pelvic pain, persistent bleeding, and no improvement. <p>

<p>Conclusion: Twice as many surgeons and lower patient-flow at SSJ compared to NLSH may have contributed to the lower success-rate at SSJ. Furthermore, the subjective satisfaction and success, and persistent bleeding and pain post-TCER, may influence whether women opt for hysterectomy. Nevertheless, further research is necessary to comprise more detailed information on the factors contributing to hysterectomy after TCER.