Abnormal Uterine Bleeding Control by Sequential Application of Hysteroscopic Lesion Morcellation and Endometrial Ablation.

Objective: To assess the efficacy and safety of combined hysteroscopic morcellation/endometrial ablation for treating abnormal uterine bleeding (AUB). Study Design: Prospective case series from 5 U.S. gynecology clinics. Women with intrauterine polyps and/or type-0 myomas and transformed Uterine Fibroid Symptom and Health-Related Quality-of-Life (UFS-HRQoL) symptom severity score ≥47 points (100 possible) underwent hysteroscopic morcellation (MyoSure) of intrauterine pathologies before endometrial radiofrequency ablation (NovaSure). Outcome measures were amenorrhea rate, UFS-HRQoL scoring, AUB retreatment/reintervention, bleeding days, and perioperative adverse events, through 12 months. Results: Of 26 enrolled women, 24 were available through study completion. Lesions were 27% myomas and 73% polyps. Procedure room time was 19±13 minutes. Complete lesion eradication occurred in 96% of women. At 12 months, amenorrhea prevalence was 46% (p<0.0001 vs. baseline), and 87% of women reported either no bleeding or normalized bleeding. Bleeding/spotting days decreased from 15.7±7.4 to 3.1±4.2 days/month (p<0.0001), symptom severity decreased from 75±13 to 12±18 points (p<0.0001), and QoL scores increased from 29±18 to 88±23 points (p<0.0001). Three women required additional AUB intervention. Perioperative adverse events were minor nausea (n=1) and abdominopelvic cramping (n=2) without sequelae. Conclusion: Sequential hysteroscopic morcellation and endometrial radiofrequency ablation of intrauterine lesions in women with AUB increases amenorrhea rate, alleviates bleeding symptoms, and improves quality of life, with an acceptable safety profile.

Twelve-month outcomes for patients undergoing hysteroscopic morcellation of uterine polyps and myomas in an office or ambulatory surgical center.

STUDY OBJECTIVE: To examine efficacy of hysteroscopic removal of polyps and myomas on health-related quality of life and symptom severity at 1-year postprocedure. DESIGN: Randomized, prospective, comparative setting clinical trial (Canadian Task Force classification II-2). SETTING: Nine outpatient obstetrics and gynecology practices and hospitals in the United States. PATIENTS: Women 18 to 55 years of age with polyps and/or type 0 or I myomas ≥1.5 and ≤3.0 cm. INTERVENTIONS: Treatment of polyps and fibroids with the MyoSure device. MEASUREMENTS AND MAIN RESULTS: A total of 118 lesions (76 polyps, 42 myomas) were removed. Among the 118 pathologies removed, 53 were removed in an office setting (28 myomas, 25 polyps), and 55 were removed in an ambulatory surgical center (ASC) setting (14 myomas, 41 polyps). The mean percentage of pathology removed was 95.9 ± 6.8% for fibroids and 99.9 ± 0.7% for polyps. Symptom severity as measured by the Uterine Fibroid Symptom-Quality of Life (UFS-QOL) scale improved significantly (p < .01) between baseline (mean score of 67.5 ± 15.4) and 12 months postprocedure (mean score of 22.3 ± 22.6). The Health-Related Quality of Life (HRQOL) scale also improved significantly (p < .01) between baseline (mean score 38.7 ± 23.3) and 12 months postprocedure (mean score of 83.9 ± 24.4). Both the office and ASC groups demonstrated a statistically significant (p < .01) improvement in UFS-QOL and HRQOL. CONCLUSION: For women with intrauterine polyps and/or myomas who experienced abnormal uterine bleeding, hysteroscopic morcellation with the MyoSure device provided significant, durable health-related, quality-of-life improvements up to 12 months postprocedure. These findings were the same for patients treated in both an office-based setting and ASCs.