ABSTRACT
Thermal balloon endometrial ablation is a new operative technique recently proposed in the treatment of dysfunctional uterine bleeding. To evaluate the efficacy of thermal balloon endometrial ablation in the treatment of dysfunctional uterine bleeding, and to identify the possible predictifs factors for a successful outcome. A prospective study was conducted including 152 patients with chronic abnormal uterine bleeding refractory to medical treatment. All patients were treated by thermal balloon endometrial ablation [Thermachoice, Gynecare] between January 1, 1996 and December 31, 2003. patients were included if their uterine cavities sounded to less than 12 cm and had undergone hysteroscopy, pelvic ultrasound and endometrial biopsy showing no structural or [pre] malignant endometrial abnormalities. A balloon catheter was placed through the cervix and after inflation in the endometrial cavity with 5% dextrose in water, was heated to 87 +/- 5°C. No one required cervical dilatation. Balloon pressures were 160 to 170mm Hg. All patients underwent 8 minutes of therapy. The average patient was 47 years [range: 30 - 62 years] and was followed for a mean of 3 years and 7 months [range: 6 month - 8 year]. 31,6% of women reported amennorhea, 16,5% hypomenorrhea and 21% eumenonrhea. Menorrhagea persisted in 11,2% of patients. No intraoperative complications and minor postoperative morbidity occurred in 10,5% of patients. Three pregnancy complicated by spontaneous abortions were reported after the treatment. A total of 78% of women reported overall satisfaction with the endometrial ablation procedure and 18% were dissatisfied. 17,8% of patients underwent hysterectomy within I to 5 years of balloon endometrial ablation. Increasing age and menopause were significantly associated with increased odds of success [p <0,05]. Thermal balloon endometrial ablation is a simple, easy, effective, and minimally invasive procedure in menhorragic women with no desire for further childbearning. The chance of successful treatment is thightly depending of several factors such as increased age and menopause, that shows the importance of patients selection. Although rare, pregnancy after endometrial ablation is possible. Women of reproductive age should have a post operative contraception method