The scope of hysteroscopic surgery in the treatment of menorrhagia
This thesis deals with the scope of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding, and in particular presents the results of a randomised controlled trial of endometrial laser ablation (ELA) versus transcervical resection of the endometrium (TCRE). In addition, the effects of prophylactic antibiotics during surgery are studied, and the results of a randomised comparison of two types of admission-discharge policies presented. The possible role of misoprostol in cervical priming prior to hysteroscopic surgery is explored. Finally, ultrasonographic findings are presented in a sub-set of women one year after endometrial ablation. Chapter 1 describes the historical background of hysteroscopy and analyses the mechanism of action of laser and electrodiathermy. Chapter 2 describes the subjects and methods used for the main randomised trial comparing ELA and TCRE. Chapter 3 presents the clinical, psychological and economic outcome of the randomised comparison of ELA and TCRE. Satisfaction rates, menstrual outcome, symptoms of pre-menstrual syndrome (PMS), re treatment rates and costs are evaluated. Chapter 4 describes the outcome of a randomised study of the incidence of bacteraemia following the use of prophylactic antibiotics during hysteroscopic surgery in a subset of women participating in the main trial. Chapter 5 examines the acceptability, efficacy and comparative costs of daycase versus overnight stage in a randomised group of women. Chapter 6 examines the effect of misoprostol on cervical resistance prior to transcervical resection of the endometrium, in the context of a randomised controlled trial. Chapter 7 compares bladder and ovarian function two years post-operatively in a group of women randomised to either hysterectomy or hysteroscopic surgery, as part of an earlier study. Chapter 8 describes transvaginal ultrasonographic findings one year after hysteroscopic surgery in a group of asymptomatic women.