Meta-analysis of bipolar radiofrequency endometrial ablation versus thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding

BackgroundHeavy menstrual bleeding is a common problem that can severely affect quality of life. ObjectivesTo compare bipolar radiofrequency endometrial ablation and thermal balloon ablation for heavy menstrual bleeding in terms of efficacy and health-related quality of life (HRQoL). Search strategyOnline registries were systematically searched using relevant terms without language restriction from inception to November 24, 2016. Selection criteriaRandomized control trials or cohort studies of women with heavy menstrual bleeding comparing the efficacy of two treatments were eligible. Data collection and analysisData were extracted. Results were expressed as risk ratios (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs). Main resultsSix studies involving 901 patients were included. Amenorrhea rate at 12months was significantly higher after bipolar radiofrequency endometrial ablation than after thermal balloon ablation (RR 2.73, 95% CI 2.00-3.73). However, no difference at 12months was noted for dysmenorrhea (RR 1.04, 95% CI 0.68-1.58) or treatment failure (RR 0.78, 95% CI 0.38-1.60). The only significant difference for HRQoL outcomes was for change in SAQ pleasure score (12months: WMD -3.51, 95% CI -5.42 to -1.60). ConclusionsBipolar radiofrequency endometrial ablation and thermal balloon ablation reduce menstrual loss and improve quality of life. However, bipolar radiofrequency endometrial ablation is more effective in terms of amenorrhea rate and SAQ pleasure. Both treatments effectively reduce menstrual loss, but bipolar radiofrequency endometrial ablation is more effective than thermal balloon ablation for amenorrhea rate and SAQ pleasure.