Radiofrequency induced endometrial ablation: an update.

OBJECTIVE To test the safety and efficiency of radiofrequency endometrial ablation as a nonhysteroscopic treatment of dysfunctional uterine bleeding. DESIGN A multicentre trial. SETTING Nineteen clinics in six countries. METHODS From February 1990 to December 1994, 1280 women were treated with radiofrequency endometrial ablation. Inclusion criteria were: menorrhagia, age 30-55 years, a completed family, a wish to retain the uterus, no hypergonadotropic state indicating an approaching menopause, a normal sized uterus, normal cervical cytology, normal adnexa, no prolapse, no intrauterine abnormalities, and no history of a bleeding disorder. Treatment was performed according to a standard operating protocol. RESULTS Either amenorrhoea or a satisfactory improvement of menstruation was obtained in 78.5% of 944 women followed for six months or more. The design of the equipment has been thoroughly revised and improved during the last four years. The complications encountered were mostly related to the handling of radiofrequency and sometimes due to failures in following the safety protocol. CONCLUSIONS Although the technology is complicated, the treatment is simple, fast and effective. The complications have often been unpredictable. Despite the improvements made during this period, safety must be further enhanced to develop the original concept into an established technique.