The investigation and treatment of abnormal uterine bleeding in the premenopausal woman
The research described in this thesis attempts to rationalise aspects of secondary care for premenopausal women with abnormal uterine bleeding, in particular investigation and assessment of a new method of endometrial ablation. The work was performed in a gynaecology unit with an established research record in endometrial ablative methods. The hospital is the main referral centre for women with menstrual disorders, enabling a centralised and stable population to be available. Chapter 1 outlines the past and present methods for the investigation and surgical treatment of abnormal uterine bleeding. Epidemiological factors for abnormal menstrual loss are discussed, as well as aetiology and the development of clinical evaluation. The equipment requirements for both transcervical resection of the endometrium (TCRE) and microwave endometrial ablation (MEATM) are described with a review of the literature to date on endometrial ablation. Chapter 2 presents a randomised comparative study of outpatient hysteroscopy and endometrial biopsy with endometrial biopsy alone for abnormal uterine bleeding. Outpatient hysteroscopy was successfully performed in almost 85% of women randomised to this procedure compared to 92% successfully receiving an endometrial biopsy alone. Hysteroscopy was found to be acceptable and viewed as a reassuring investigation. However, there was no difference in clinical outcomes between the two groups. Chapter 3 describes the subjects and methods used in a prospective randomised trial comparing MEATM with TCRE. Operative details and outcomes at one year are presented. MEATM was found to be a significantly faster endometrial ablative method than TCRE. The postoperative stay was less with MEATM, though not significantly and analgesic requirements were low in both groups. Satisfaction and acceptability rates with treatment were equivalent.