Non invasive versus minimally invasive technique in management of dysfunctional uterine bleeding

الملخص EN

Objective: To evaluate and assess the efficacy of two lines for treatment of dysfunctional uterine bleeding: the first was minimally invasive technique (endometrial ablation) and the second was application of levonorgestril loaded device (Mirina).

Setting: This study was done at El Nour Hospital, Holly Mecca, Saudi Arabia in collaboration with the endoscopy Unit in Bab-El-Sharia University Hospital, Al- Azhar University Cairo, Egypt all over the period from May, 15th, 1998 to January, 20th, 2000.

Methods: 50 patients complaining of DUB had been recruited to this study.

Patients were divided randomly into two groups.

Group I: 25 patients for whom Levonorgestril loaded IUD were inserted.

Group II: 25 patients for whom endometrial ablation was done using resectoscope wire loop electrode, endometrial shaving performed to a depth of 3 to 4 mm with a cutting current of approximately 100-110 watt.

Then follow up at 6 and 12 months post-therapy as regard menstrual patterns and patient's satisfaction.

Endometrial biopsies in all patients were assessed pre and 12 months post therapy.

Results: Endometrial activity regression detected in 80% and 44% in Group I and II respectively with a statistically significant difference (P< 0.01).

The improvement Incidence in 6 and 12 months post-therapy were 92%, 88% in Group I and 80%, 56% in Group II.

The relationship in both groups, In spite the improvement being of been statistically insignificant after 6 months, it was significant after 12 months with a better results in Group I (P< 0.01).

Patient's satisfaction was higher in group I than in group II.

In group I it was 85% and 87% in 6th and 12th month post- therapy, while in-group II it was 72% & 52%.

Conclusion: Levonorgestril loaded device could be considered as a simple, non- expensive, non-invasive, effective, and safe tool in the management of dysfunctional uterine bleeding with a high convenient incidence of patient's satisfaction as well as been noted of leading to the minimal side effects.

In this study, LNG-IUDs found to be more successful than endometrial ablation as regard to the better outcome, patient's satisfaction, endometrial regression activity, simplicity and safety of the technique that requires neither anesthesia nor hospitalization and can be easily performed as an outpatient procedure.

Beside its benefit of acting as a temporary contraceptive so will be of great benefit when future fertility is required in such cases