A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow up at a minimum of five years

Objective To compare long term outcomes following microwave endometrial ablation (MEA) or transcervical resection of the endometrium (TCRE). Design Follow up of a randomised controlled trial. Setting Gynaecology department of a large UK teaching hospital. Population/Sample Two hundred and thirty-nine participants in a randomised comparison of MEA with TCRE. Methods Collection of patient completed postal questionnaires and operative databank review. Main outcome measures Women's satisfaction with and acceptability of treatment, menstrual symptoms, changes in health-related quality of life and additional treatments received. Results Two hundred and thirty-six of the original 263 women returned questionnaires (90%) after a minimum of five years post-treatment. Women allocated to MEA were significantly more likely to be totally or generally satisfied with treatment (86% vs 74%; difference 12%, 95% CI 2% to 23%), to find it acceptable (97% vs 91%; difference 6%, 95% CI 1% to 13%) and would recommend it (97% vs 89%; difference 8%, 95% CI 1% to 14%). Bleeding and pain scores were highly significantly reduced following both MEA and TCRE, achieving amenorrhoea rates of 65% and 69%, respectively. The hysterectomy rate after a minimum of five years was 16% in the MEA and 25% in the TCRE arm. Conclusions Both techniques achieve significant and comparable improvements in menstrual symptoms, and health-related quality of life. While high rates of satisfaction with treatment and acceptability of treatment are achieved by TCRE, these are significantly lower than levels following MEA. These long term data, when combined with the trials' operative findings and known costs of both procedures, now inform us that MEA is a more effective and efficient treatment for heavy menstrual loss than TCRE.