الفهرس 
Assessment of menstrual blood lossOnly 14 pages are availabe for public view
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Abstract
Menorrhagia is one of the most common clinical
problems encountered by gynecologists. It represents 12% of all gynecological referrals.
Many of the women are initially prescribed medical treatment by gynecologists; these are known to
reduce blood loss in a significant proportion of womt:n with objectively proven menorrhagia. Many
of those who do not respond to, are unable to tolerate, or are unwilling to attempt this approach
will tmdergo hysterectomy as the final answer. By the age of 43, 10% of all women would have a
hysterectomy and more than 50% of which are for menorrhagia.
·Many women do not want to have a hysterectomy, particularly if they have been reassured that the
uterus is normal; these women would prefer a simple and less invasive procedure. Since the 1980s,
endometrial ablation and resection techniques have been introduced and have gained popularity for
their ability to treat menstrual problems successfully, without the need for hysterectomy.
In this study, we aimed to compare two techniques of hysteroscopic endometrial ablation, which are
endometrial resection and roller-ball diathermy, in the treatment of menorrhagia. Thirty patients
had been recruited from the gynecology out-patient clinic of Ain Shams University Hospital
presenting with menorrhagia, that had failed to be controlled medically for at least three months.
Their age ranges from 30 to
52 years, completed their families, with a normal sized uterus or mild symmetrical enlargement
and with no large fibroids or other pelvic pathology.
Patients were preoperatively evaluated by history, clinical examination, pelvic ultrasonography,
diagnostic hysteroscopy and endometrial sampling. They were randomly allocated using opaque sealed
envelopes into group I (treated by endometrial resection) and group II (treated by roller-ball
diathermy).
Endometrial resection was conducted through a continuous flow hysteroscopic resectoscope with loop
electrode fitted, while roller-ball diathermy was performed with roller ball electrode fitted. All
procedures were p rformed under general anaesthesia. The distension fluid used was 1.5% Glycine.
After the procedure, the patients’ conditions were followed monthly for 3 months.
The mean operative time was 42.6 min; and the mean fluid deficit was 542 ml. Intrauterine balloon
inflation was used in five cases as uterine tamponade and removed 12 hours later. No operative
complications were recorded during either of the procedures except for one case of post-operative
fever that resolved within one day.
Twenty-five out of thirty women (83.3%) had been adequately controlled for menorrhagia
(36.6% had amenorrhea, 46.6% had hypomenorrhea), while five women (16.6%) had treatment
failure due to persistent menorrhagia after surgery.
A second surgical procedure, in the form of hysterectomy was done in the five patients with
persistant menorrhagia: three patients 18.75% after endometrial resection (n=16), two patients
14.3% after roller-ball diathermy (n=14). Histopathology of uteri revealed, focci of adenomyosis
in three
cases and one case of intramural fibroid l.5xl.5cm undiagnosed preoperatively.
In conclusion: Endometrial ablation is effective and safe in controlling menonhagia. Endometrial
roller-ball diathermy was as effective as endometrial resection but associated with lower operative
t1uid deficit and operative blood loss.