Jed Hawe

A double-blind randomized trial comparing the Cavaterm™ and the NovaSure™ endometrial ablation systems for the treatment of dysfunctional uterine bleeding

OBJECTIVE To compare two second-generation endometrial ablation systems in women with dysfunctional uterine bleeding (DUB) who want conservative surgical treatment. DESIGN A double-blind, randomized trial. SETTING A minimal access gynecological surgery unit in northeast England. PATIENT(S) Fifty-seven women diagnosed with DUB were recruited, with 55 undergoing surgery and completing 12-month follow-up. INTERVENTION(S) Thirty-seven women underwent a NovaSure endometrial ablation, and 18 had a Cavaterm endometrial ablation. Clinical and quality of life data were collected 6 and 12 months after treatment. MAIN OUTCOME MEASURE(S) Amenorrhea, menstrual change, quality of life, sexual activity, patient satisfaction, and procedure acceptability. RESULT(S) Amenorrhea, hypomenorrhea, eumenorrhea, and menorrhagia rates for the Cavaterm and Novasure groups at 12 months were 2/18 (11%) vs. 16/37 (43%); 11/18 (61%) vs. 10/37 (27%); 5/18 (27%) vs. 6/37 (16%); and 0/18 vs. 5/37 (13%), respectively. At 12 months, 83% and 92% of women were either satisfied or very satisfied in the Cavaterm or Novasure groups, respectively. There were no major complications in either group. CONCLUSION(S) Both the Cavaterm and the Novasure endometrial ablation systems are effective in reducing menstrual loss in women with DUB and achieve high rates of patient satisfaction. The Novasure system achieved a statistically significantly higher rate of amenorrhea in this study.

A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding

Objective To compare the effectiveness of the Cavaterm thermal balloon endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding.

Quality of Life Should Be Considered the Primary Outcome for Measuring Success of Endometrial Ablation

STUDY OBJECTIVE To compare clinical and quality of life outcomes by validated instruments after endometrial ablation by four methods, and determine the primary outcome that most reflects procedure success. DESIGN Descriptive cohort study (Canadian Task Force classification II-2). SETTING Minimal-access gynecologic surgery unit in northeast England. PATIENTS One hundred thirty-nine women. INTERVENTION Endometrial ablation by one of four methods: Cavaterm, endometrial laser interstitial thermotherapy (ELITT), endometrial laser ablation (ELA), or NovaSure impedance-controlled system. MEASUREMENTS AND MAIN RESULTS Clinical outcomes were assessed according to menstrual outcome. Whereas amenorrhea rates were significantly different among the four techniques (chi2 = 9.42, p = 0.02), combined amenorrhea and hypomenorrhea rates were not significantly different (67%, 69%, 69%, 62%, chi2 = 0.38, NS) for Cavaterm, ELITT, ELA, and NovaSure, respectively. Quality of life, measured preoperatively by the EQ-5D index and EQ-5D vas, SF-12 physical and mental component scores, and sexual activity questionnaire pleasure, habit, and discomfort scores, were substantially improved 12 months after treatment. No significant differences were seen in quality of life scores between women after endometrial ablation and the general population. CONCLUSION Quality of life for women with menorrhagia is improved to a normal level by treatment with either first- or second-generation endometrial ablation.

Pelvic Pain Scores in Women without Pelvic Pathology

STUDY OBJECTIVE To assess the presence of and quantify pelvic pain in a group of women without demonstrable pelvic pathology as confirmed by laparoscopy. DESIGN Prospective observational study (Canadian Task force classification II-2). SETTING District general hospital. PATIENTS One hundred forty-three consecutive women undergoing laparoscopy for sterilization, infertility investigation, or assessment of pelvic pain. INTERVENTION Laparoscopy. MEASUREMENTS AND MAIN RESULTS Women were asked to complete a questionnaire including a visual analog score for four different types of pelvic pain (dysmenorrhea, pelvic pain, dyspareunia, rectal pain) and three quality of life assessments. Forty-three women were excluded due to pelvic pathology. In the 100 remaining women, mean pain scores (maximum 10) were dysmenorrhea 3.77, pelvic pain 1.75, dyspareunia 1.54, and rectal pain 1.07. Quality of life assessment was no different from that in a healthy population in whom the instruments were validated. CONCLUSION Pelvic pain, principally dysmenorrhea, is common in women of reproductive age. Pain scores may be used to compare treatments for pelvic pain and provide useful information for preoperative counseling.