Dissertation

Epidemiological features of heavy menstrual loss and an evaluation of endometrial surgical techniques

Cooper, Kevin G

1999

Overview

The research described in this thesis endeavours to rationalise certain aspects of the secondary care management of women with heavy menstrual loss, particularly endometrial surgery. The work was undertaken in a gynaecology department with an established record in research evaluating endometrial ablative techniques. The hospital is the regional referral centre for all women with menstrual disorders; hence a centralised and stable study population was available. Chapter 1 outlines the aetiological and known epidemiological factors for dysfunctional uterine bleeding. A review of the medical treatment options for menorrhagia is undertaken. The equipment requirements and techniques of transcervical resection of the endometrium (TCRE) and microwave endometrial ablation (MEA) are described. The randomised controlled trials evaluating TCRE that have been published to date, are discussed and critically reviewed. Chapter 2 presents the patterns of referral, socio-demographic and clinical details, primary care treatment, and effect on health related quality of life of women referred to this centre, over one year with heavy menstrual loss. Chapter 3 describes the subjects, methods and outcomes at four months of a prospective randomised comparison of medical management with TCRE for women with heavy menstrual loss. Chapter 4 outlines the clinical and quality of life outcomes at two years for the randomised trial of medical treatment versus TCRE. Chapter 5 describes the subjects and methods for a prospective randomised controlled trial comparing MEA with TCRE. Operative details and outcomes at four months are presented. MEA was a significantly faster technique than TCRE (11.4 v 15 minutes). Post operative stay was less with microwave, though not significantly so, and analgesia requirements were low and equivalent (<30%) for both techniques. Satisfaction rates were slightly lower following MEA (74% v. 81%), whilst acceptability of treatment rates were equivalent (92% v 94%). MEA lead to more significant improvements in health related quality of life measurements than TCRE. Chapter 6 concludes that: - Primary care management guidelines are required, whilst treatment preferences and expectations should be established prior to deciding on treatment. Quality of life measurements should be used to determine degree of debilitation and to ascertain treatment success. Medical treatment was less effective than TCRE, irrespective of previous treatment or type of medical management received.

• Publisher: ProQuest Dissertations & Theses
• Subject: Medical referrals / Medical treatment / Menstruation / Obstetrics / Primary care / Quality of life