oa The Combined Use Of Thermachoice Ablation And Mirena In The Management Of Heavy Menstrual Bleeding

Introduction Heavy menstrual bleeding (HMB) commonly affects 1.5 million women in the UK, thereby prompting 1 in 20 women of reproductive age to seek treatment to improve their quality of life. The NICE guidelines recommend the use of Mirena in treating benign HMB, followed by endometrial destruction, if medical treatments fail to resolve symptoms. Several studies have shown the efficacy and cost-effectiveness of using Mirena, endometrial ablation and hysterectomy individually, but evidence on the efficacy of combining endometrial ablation and Mirena compared with other treatments remains inadequate. The objective of this study was to evaluate the efficacy and outcomes of women with HMB via combined use of Thermachoice ablation and Mirena. Methods Forty-nine patients with persistent HMB following initial treatment involving either Mirena, Thermachoice ablation or medical treatments were randomly selected from the sample population between 2005 to 2011 and consented to have combined Thermachoice ablation and Mirena. Our primary outcome measures were satisfaction levels 6 months post-treatment, amenorrhoea rates and rates of subsequent hysterectomy. Results There were similar number of patients in the each age group, including aged 35 to 40 (15 patients), 41 to 45 (17 patients) and 46 to 50 (15 patients), except for 2 patients aged beyond 50. 33 of 49 patients had at least two live births and BMI of above 30 respectively. 36 (73%) patients had normal pelvic scan findings, 10 patients had abnormal findings and subsequent histology specimen excluded hyperplasia, atypia and malignancy, and 3 patients had inconclusive findings due to high BMI. Out of 49 patients, 18 (37%) had Mirena, 2 (4%) had Thermachoice ablation and 29 (59%) had medical treatments after declining Mirena initially. Following initial treatment, 16 patients with Mirena and all patients who had ablation and medical treatments (96%) developed initial spotting that persisted to severe loss. Following subsequent counselling and combined treatment of Thermachoice ablation and Mirena, 38 (78%) patients were very satisfied with their symptoms (3 of 3 satisfaction ratings), 36 (73%) patients had high amenorrhoea rates and only 11 (22%) patients had persistent spotting that led to a hysterectomy. No other serious complications occurred in these patients following subsequent treatment. Conclusion The combined use of Thermachoice ablation and Mirena in treating HMB remains justified based on the overall outcomes and a large prospective study is required to compare its efficacy with other treatments. References 1. Vaughan D, Byrne P. J Obstet Gynaecol 2012 May; 32(4): 372-4.