Uterine hemodynamic study after endometrial thermoablation therapy in dysfunctional uterine bleeding [DUB]

ABSTRACT

to study the hemodynamic changes in uterine artery blood flow using transvaginal color Doppler ultrasonography after endometrial thermoablation therapy in cases of DUB. Prospective randomized study. Al Zahraa University Hospital-Al Azhar University.-Al Haram Hospital for Research and Treatment. Some private hospitals-Egypt. Patients and Fifty premenopausal patients with DUB without obvious structural or premalignant lesions. All patients were in good health and they were submitted to pelvic ultrasonography, pap smear diagnostic hysteroscopy and endometrial biopsy within 6 months of our management. Those patients were randomly divided into 2 groups first group included 22 patients who received thermal balloon endometrial ablation therapy. Second group included 25 patients who had medical treatment "a three-months period of medroxy progesterone acetate "10 mg/day". The uterine thermal balloon ablation therapy [Thermachoice] was carried out on cycle days 3-8. Color Doppler measurements were also carried on cycle days 3-8. Flow waveforms were obtained from the main branch of the uterine arteries at the level of the inner cervical os on both sides. Doppler flow parameters were used for subsequent statistical analysis. The measurements took place before the initiation of treatment, on the first post operative day "thermal ablation group only" and 3, 6 months and one year after initiation of the study. Endometrial thermoablation was effective in the treatment of DUB. 20/22 women [90.9%] had amenorrhea, only 2 patients "9.1%" underwent hysterectomy during the follow up period because of problems related to pelvic heaviness recurrent uterine spotting or offensive discharge. The pulsatility index "PI" was significantly higher after endometrial ablation than pretreatment level. The PI was gradually increased throughout the period of follow up [2.8 +/- 0.9 and 2.9 +/- 0.8] at 6 and 12 months post-treatment VS [2.1 +/- 0.5] pretreatment. The hysterectomy rate was significantly higher in the medical therapy group than in thermoablation group "35.7% VS 9.1"-No statistically significant change in uterine artery PI took place after medical therapy. Thermal balloon endometrial ablation therapy induces a gradual rise in uterine artery blood flow impedance which was statistically significant at 6 and 12 months. This rise in impedance may be due to fibrosis in the uterine cavity induced by thermal balloon therapy. The uterine cavity fibrosis is a good marker for therapy success. Thermoablation technique was accepted by the patients with a high efficacy rate "90.9%"