EFFECTIVENESS OF ENDOMETRIAL ABLATION IN TREATING HEAVY MENSTRUAL BLEEDING

Abstract

Background

Heavy menstrual bleeding is a common gynecological complaint that affects women’s physical health, emotional well-being, and quality of life. In many developing countries, including Pakistan, it is frequently associated with iron deficiency anemia and reduced daily functioning. Endometrial ablation has emerged as a minimally invasive alternative to hysterectomy for women who have completed their families and have not responded to medical treatment. However, local evidence regarding its effectiveness and long-term outcomes remains limited.

Objective

To evaluate the effectiveness of endometrial ablation in the management of heavy menstrual bleeding, focusing on symptom reduction, patient satisfaction, improvement in anemia, need for further intervention, and reproductive outcomes in women.

Methods

This prospective clinical trial was conducted over two years in the Department of Obstetrics and Gynecology at a tertiary hospital in Islamabad. A total of 140 women aged 30–50 years with heavy menstrual bleeding unresponsive to medical therapy were enrolled. Women desiring future fertility, those with uterine malignancy, large fibroids distorting the cavity, or active pelvic infection were excluded. All participants underwent second-generation endometrial ablation using a bipolar radiofrequency device. Follow-up assessments were conducted at 1, 3, 6, 12, and 24 months. Primary outcome was reduction in menstrual bleeding at 12 months. Secondary outcomes included change in hemoglobin level, patient satisfaction, complication rate, need for repeat intervention or hysterectomy, and post-procedure pregnancy. Data were analyzed using SPSS version 25, with p < 0.05 considered statistically significant.

Results

At 12 months, 58 patients (41.4%) achieved amenorrhea and 56 (40.0%) reported significant reduction in menstrual flow, giving an overall treatment success rate of 81.4%. Only 8 patients (5.7%) experienced worsening symptoms. Mean hemoglobin level improved significantly from 9.8 ± 1.1 g/dL pre-procedure to 11.6 ± 0.9 g/dL at 12 months (p < 0.001). Patient satisfaction was high, with 78.6% reporting being satisfied or very satisfied. Complications were mild and included transient pain (15.7%), temporary bleeding (7.1%), and infection (4.3%); no major surgical complications were observed. During 24 months of follow-up, 8.6% required hysterectomy and 7.1% underwent repeat ablation. Three pregnancies (2.1%) occurred, all in women not using reliable contraception, and were associated with adverse outcomes.

Conclusion

Endometrial ablation is an effective and safe treatment option for heavy menstrual bleeding in appropriately selected women who have completed childbearing. It significantly reduces menstrual blood loss, improves anemia, and achieves high patient satisfaction with a low complication rate. In a tertiary care setting in Pakistan, it provides a valuable uterus-preserving alternative to hysterectomy. Careful patient selection, proper counseling, and reliable contraception are essential to optimize outcomes.