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  • Title: Endometrial ablation for postmenopausal uterine bleeding induced by hormone replacement therapy.
    Author: Phillips DR.
    Journal: J Am Assoc Gynecol Laparosc; 1995 Aug; 2(4):389-93. PubMed ID: 9050590.
    Abstract:
    STUDY OBJECTIVE: To determine the effectiveness of transcervical endometrial ablation or endomyometrial resection for treating refractory postmenopausal uterine bleeding induced by hormone replacement therapy (HRT). DESIGN: Prospective observational study. SETTING: Community, teaching, and proprietary hospitals. PATIENTS: Twenty-nine postmenopausal women experiencing troublesome uterine bleeding while taking hormones. INTERVENTIONS: Hormone manipulation, office hysteroscopy or sonohysterography, endometrial curettage, and transcervical endometrial ablation or endomyometrial resection were performed in all 29 patients. MEASUREMENTS AND MAIN RESULTS: Twenty-seven women (93.1%) who continued HRT became amenorrheic within 2 months of surgery. The two who did not have irregular, intermittent spotting, but neither one required or desired further surgical intervention. Five women discontinued HRT from 3 to 53 months postoperatively (mean 12.5 +/- 8.2 mo) because of apprehension about developing breast cancer and for personal reasons. The 24 (82.8%) who continued HRT were observed for as long as 99 months (mean 36.4 +/- 5.5 mo); 22 (91.6%) of them remained amenorrheic. Pathologic examination of tissue specimens revealed atrophic endometrium in 4 patients, adenomyosis in 7, simple hyperplasia in 4, submucous leiomyomas in 11, endometrial polyps in 4, and proliferative endometrium in 1. There were no perioperative complications. CONCLUSION: Endometrial ablation or endomyometrial resection was an effective alternative to discontinuing HRT for these postmenopausal women whose uterine bleeding was unrelieved by modification of their sex steroid regimens.
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