Time to hysterectomy following transcervical resection of the endometrium based on age: a retrospective cohort review

Abnormal uterine bleeding (AUB) affects 1 in 5 Australians of reproductive age [1]. For patients seeking intervention, if pharmacological management fails or is not appropriate the surgical options of endometrial ablation (EA) and hysterectomy are available [2,3]. Both options offer high satisfaction rates for the treatment of AUB [4]. The Australian Commission on Safety and Quality in Healthcare recommends offering EA before hysterectomy, in the absence of significant structural uterine pathology, highlighting the benefits of EA being a uterine sparing and less invasive procedure [5].

EA is the surgical removal or destruction of the endometrial tissue to reduce bleeding [6]. In Australia, the EA procedures performed are transcervical resection of the endometrium (TCRE) using a loop, rollerball EA, bipolar radiofrequency EA (Novasure®) and balloon EA [7].

If EA is unsatisfactory in treating AUB further surgical intervention may be required. The rate of hysterectomy after EA varies between 13-29% in the literature [8-12]. The median time to subsequent hysterectomy has been reported as 15 months, and Kalampokas et al. found that 75.2% of patients had a hysterectomy within the first 5yrs following EA [8,13]. Prognostic factors for requiring a subsequent hysterectomy include younger age, prior tubal ligation and pre-existing dysmenorrhea [11,14,15]. In Australia, the rate of hysterectomy following EA was found to be 10% during 1991 and 17.6% in 2021 [16, 17].

This study aimed to evaluate the effectiveness of TCRE in the management of AUB in appropriately selected patients, depending on age, to provide an up-to-date rate based on age categories, aiding the informed decision making of patients presenting for surgical intervention for AUB.

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