Abnormal Uterine Bleeding Control by Sequential Application of Hysteroscopic Lesion Morcellation and Endometrial Ablation

OBJECTIVE: To assess the efficacy and safety of combined hysteroscopic morcellation/endometrial ablation for treating abnormal uterine bleeding (AUB). STUDY DESIGN: Prospective case series from 5 U.S. gynecology clinics. Women with intrauterine polyps and/or type-0 myomas and transformed Uterine Fibroid Symptom and HealthRela ted Quality-of-Life (UFS-HRQoL) symptom severity score >= 47 points (100 possible) underwent hyster-oscopic morcellation (MyoSure) of intrauterine pathologies before endometrial radiofrequency. ablation (NovaSure). Outcome measures were amenorrhea rate, UFS-HRQoL scoring, AUB retreatment/reintervention, bleeding days, and perioperative adverse events, through 12 months. RESULTS: Of 26 enrolled women, 24 were available through study completion. Lesions were 27% myomas and 73% polyps. Procedure room time was 19 +/- 13 minutes. Complete lesion eradication occurred in 96% of women. At 12 months, amenorrhea prevalence was 46% (p <0.0001 vs. baseline), and 87% of women reported either no bleeding or normalized bleeding. Bleeding/spotting days decreased from 15.7 +/- 7.4 to 3.1 +/- 4.2 days/month (p <0.0001), symptom severity decreased from 75 +/- 13 to 12 +/- 18 points (p<0.0001), and QoL scores increased from 29 +/- 18. Three women required additional AUB intervention. Perioperative adverse events were minor nausea (n=1) and abdominopelvic cramping (n=2) without sequelae. CONCLUSION: Sequential hysteroscopic morcellation and endometrial radiofrequency ablation of intrauterine lesions in women with AUB increases amenorrhea. rate, alleviates bleeding symptoms, and improves quality of life, with an acceptable safety profile.