-
Obstetrics and Gynecology 02/2013; 121(2 Pt 1):382. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To compare the efficacy and safety of endometrial ablation (EA) among obese versus non-obese women. METHODS: A retrospective cohort study of 666 women who underwent EA at the Mayo Clinic, Rochester, USA, between January 1, 1998, and December 31, 2005, was conducted. Obesity was defined as a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of 30 or above. Outcome measures included treatment failure and amenorrhea. Regression models were used to compare outcomes and adjust for known confounders. RESULTS: The mean BMI was 29.6±7.7; 263 women (39.5%) were classified as obese. No difference was observed in treatment failure at 5years between the obese and non-obese cohorts (11.6% vs 9.7%) with an adjusted hazard ratio of 0.96 (95% confidence interval [CI], 0.60-1.53; P=0.878). The crude 12-month amenorrhea rate was higher among non-obese than obese women (24.3% vs 17.5%); however, this difference was not significant after adjusting for known predictors of amenorrhea. The odds ratio was 1.28 (95% CI, 0.75-2.19; P=0.366). Adverse events were rare and comparable between the cohorts. CONCLUSION: The use of EA is a safe and effective option for women with obesity.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 01/2013; · 1.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: STUDY OBJECTIVE: To compare the long-term outcomes of intrauterine morcellation (IUM) of endometrial polyps vs a traditional operative polypectomy technique, hysteroscopic resection (HSR), and to identify factors predictive of recurrent abnormal uterine bleeding (AUB) after operative polypectomy. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Minimally invasive gynecologic surgery practice in a tertiary care center. PATIENTS: Women who underwent operative hysteroscopic polypectomy between January 1, 2004 and December 31, 2009. INTERVENTIONS: Intrauterine morcellation or HSR with evaluation and/or treatment of recurrent AUB after operative polypectomy. MEASUREMENTS AND MAIN RESULTS: Of 311 patients (IUM group, 139; HSR group, 172), 167 (53.7%) had at least 1 gynecologic follow-up visit and 57 (18.4%) had recurrent AUB. Subsequent gynecologic clinic visit rates were similar between the 2 groups (HSR, 58.1%, vs IUM, 48.2%; p = .08). Recurrence of AUB within the first 4 years of follow-up was similar between the IUM and HSR groups (hazard ratio for HSR vs IUM, 1.12; 95% confidence interval, 0.64-1.98; p = .59). However, recurrence of endometrial polyps approached statistical significance (hazard ratio, 3.3; 95% confidence interval, 0.94-11.49; p = .06). Premenopausal status, history of hormone replacement therapy, multiparity, and polycystic ovarian syndrome were independently associated with AUB recurrence. There were no reports of inability to establish a histopathologic diagnosis among all pathology specimens evaluated. CONCLUSION: Compared with HSR, intrauterine morcellation may be associated with lower recurrence of endometrial polyps. However, the incidence of recurrent AUB is independent of polypectomy method.
Journal of Minimally Invasive Gynecology 01/2013; · 1.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: To determine pelvic ultrasound characteristics in women after radiofrequency endometrial ablation (EA) and evaluate the association of those characteristics with symptoms and the need for subsequent therapeutic intervention. METHODS: This retrospective cohort study evaluated patients who underwent transvaginal pelvic ultrasound after radiofrequency EA between July 3, 2006, and November 13, 2009. The presence or absence of postablation symptoms (pelvic pain or vaginal bleeding) at the time of ultrasound defined the 2 groups. Two radiologists evaluated 17 ultrasound parameters. Demographic, clinical, and ultrasound characteristics were compared between symptomatic and asymptomatic patients, and features were assessed for association with subsequent therapeutic interventions. RESULTS: Of the 91 patients who had radiofrequency EA and subsequent ultrasound, 63 patients (69.2%) were symptomatic on evaluation. Symptomatic patients were significantly more likely than asymptomatic patients to have an endometrial thickness of 3 mm or more, a heterogeneous endometrial echotexture, and leiomyomas (P = 0.004, P = 0.008, and P = 0.05, respectively). The most frequent finding in all patients was an indistinct endometrial border (66/79 [83.5%]). In addition, there was a tendency for patients with leiomyomas to have a subsequent intervention (P = 0.07). Although infrequent, all patients (7/91) with cornual hematometra or proximal hydrosalpinx had pain. CONCLUSIONS: Indistinct endometrial border is a common finding after radiofrequency EA and is unrelated to the presence or absence of symptoms. Patients who present with post-radiofrequency EA symptoms seem to have a few specific ultrasound characteristics that differentiate them from asymptomatic patients. The presence of leiomyomas on ultrasound is predictive of the need for therapeutic interventions.
Ultrasound quarterly 11/2012;
-
[show abstract]
[hide abstract]
ABSTRACT: : To identify risk factors for endometrial cancer after benign results of endometrial biopsy or dilation and curettage (D&C).
: Nested case-control study from Rochester Epidemiology Project data. Among 370 Olmsted County, Minnesota, residents who received an endometrial cancer diagnosis between 1970 and 2008, we identified 90 patients (24.5%) who had previous benign endometrial biopsy or D&C results (no atypical hyperplasia). We compared them with 172 matched control group participants who had benign endometrial biopsy or D&C results without subsequent endometrial cancer.
: Using a multivariable conditional logistic regression model, we found that oral contraceptive pill (OCP) use was protective (odds ratio [OR] 0.18, 95% CI [CI] 0.08-0.45; P<.001), and personal history of colorectal cancer (OR 4.44, 95% CI 1.02-19.31; P<.05), endometrial polyp (OR 4.12, 95% CI 1.40-12.17; P=.01), and morbid obesity (OR 3.40, 95% CI 1.18-9.78; P<.03) were independently associated with subsequent endometrial cancer. Compared with the presence of no risk factor, presence of one and two or more risk factors increased the risk of endometrial cancer by 8.12 (95% CI 3.08-21.44) and 17.87 (95% CI 5.57-57.39) times, respectively. Assuming a 2.6% lifetime risk of endometrial cancer, ORs of 8.12 and 17.87 for one and two or more of the four aforementioned risk factors confer a lifetime risk of approximately 18% and 32%, respectively.
: One fourth of patients with endometrial cancer had previous benign endometrial biopsy or D&C results. Personal history of colorectal cancer, presence of endometrial polyps, and morbid obesity are the strongest risk factors for having endometrial cancer after a benign endometrial biopsy or D&C result, and OCP use is the strongest protective factor.
: II.
Obstetrics and Gynecology 11/2012; 120(5):998-1004. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine feasibility and efficacy of direct aspiration endometrial biopsy via the fluid channel of a flexible diagnostic hysteroscope.
Retrospective review (Canadian Task Force classification II-3).
Abnormal uterine bleeding clinic in a tertiary care center.
All women who underwent direct aspiration endometrial biopsy from January 2007 through August 2011 via a flexible diagnostic hysteroscope because traditional office-based endometrial biopsy using a suction piston device was not technically possible.
Diagnostic hysteroscopy followed by direct aspiration endometrial biopsy, accomplished by applying suction to the fluid channel of a 3.1-mm flexible diagnostic hysteroscope via a 10-mL syringe. The hysteroscope tip was agitated within the uterine cavity to obtain a tissue sample.
The median age of the 32 identified patients was 50 years; 18 women (56%) were nulliparous, and 10 (31%) were postmenopausal. Thirty-one patients underwent hysteroscopy/direct aspiration biopsy because of abnormal uterine bleeding or postmenopausal bleeding. The vaginoscopic approach was used in 19 patients (59%). Indications for direct aspiration endometrial biopsy included cervical stenosis, inability to pass the endometrial biopsy instrument into the uterine cavity, and patient intolerance of endometrial biopsy. Adequate endometrial samples were obtained in 28 patients (87.5%). In 3 of 4 patients in whom direct aspiration endometrial biopsy did not provide sufficient tissue, hysteroscopy revealed an atrophic-appearing endometrium. The direct aspiration endometrial biopsy diagnosis was confirmed in 5 of 7 patients who subsequently underwent dilation and curettage or hysterectomy.
Direct aspiration endometrial biopsy is a simple and effective endometrial sampling method when traditional office-based endometrial biopsy is not feasible. Further prospective studies including larger populations are needed to confirm these results.
Journal of Minimally Invasive Gynecology 03/2012; 19(4):490-3. · 1.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of the study was to evaluate the efficacy and safety of global endometrial ablation in women with a history of cesarean delivery.
We performed a historical cohort study of patients who underwent endometrial ablation for menorrhagia between 1998 and 2005. Outcome measures included amenorrhea, treatment failure, and operative complications. Time to treatment failure was compared using Kaplan-Meier analysis. Risk adjustments were performed using Cox and logistic regression models.
Of 704 patients meeting inclusion criteria, 162 (23%) had a history of 1 or more cesarean deliveries. Women with and without a history of cesarean delivery had comparable rates for 5 year cumulative endometrial ablation failure, amenorrhea, treatment failure, and operative complications. The type of ablation device and number of previous cesarean deliveries did not affect any outcomes.
The efficacy and safety of endometrial ablation are comparable in women with or without a history of cesarean delivery.
American journal of obstetrics and gynecology 07/2011; 205(5):450.e1-4. · 3.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to describe health-related quality of life and satisfaction after global endometrial ablation in women with bleeding disorders and a systematic review of the literature.
A follow-up survey was mailed to 36 patients with bleeding disorders and 110 reference patients (no coagulopathies) who underwent global endometrial ablation for menorrhagia. The survey included a generic (SF-12) and menorrhagia multi-attribute utility scale questionnaires.
Ninety-six women (66%) responded. The total menorrhagia multiattribute utility scale score increased from 35-100 in bleeding disorder cohort (P = .03) and from 48-100 in the reference cohort (P < .001). Although postablation SF-12 mental domain scores were comparable in both cohorts (55 vs 55; P = .67), physical domain scores were lower in the bleeding disorder cohort (50 vs 56; P < .001). High satisfaction was reported by both cohorts (95% vs 84%; P = .60).
Global endometrial ablation improved health-related quality of life for women with bleeding disorders and had high satisfaction rates.
American journal of obstetrics and gynecology 04/2010; 202(4):348.e1-7. · 3.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to compare surgical-site infection rates in obese women who had extended prophylactic antibiotic (EPA) vs standard prophylactic antibiotic.
An electronic records-linkage system identified 145 obese women (body mass index, >30 kg/m(2)) who underwent combined hysterectomy and panniculectomy from January 1, 2005, through December 31, 2008. The EPA cohort received standard antibiotics (cefazolin, 2 g) and continued oral antibiotic (ciprofloxacin) until removal of drains. Regression models were used to adjust for known confounders.
The mean age was 56.0 + or - 12.1 years, and mean body mass index was 42.6 + or - 8.4 kg/m(2) (range, 30-86.4 kg/m(2)). The EPA cohort experienced fewer surgical-site infections (6 [5.9%] vs 12 [27.9%]; P < .001; adjusted odds ratio, 0.16; 95% confidence interval, 0.04-0.51; P < .001), had lower probability of incision and drainage (3 [2.9%] vs 5 [11.6%]; P = .05), and required fewer infection-related admissions (5 [4.9%] vs 6 [13.9%]; P = .08).
Extended antibiotic prophylaxis can reduce surgical-site infections in obese women after combined hysterectomy and panniculectomy.
American journal of obstetrics and gynecology 03/2010; 202(3):306.e1-9. · 3.28 Impact Factor
-
Obstetrics and Gynecology 07/2009; 113(6):1370-1. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The risk of adverse effects of fetal exposure to the levonorgestrel intrauterine system (LNG-IUS) has not been established.
In this case report and literature review, we describe a pregnant patient with an intraperitoneal LNG-IUS and the subsequent maternal and neonatal outcomes. A systematic literature search was performed to identify similar clinical reports. The MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, Web of Science and Scopus databases were searched from inception through March 2007.
The pregnancy progressed uneventfully and culminated in the elective cesarean delivery of a full-term healthy boy. Of the 35 pregnancies identified in the literature review (34 pregnancies with intrauterine LNG-IUS and 1 term delivery with intraperitoneal LNG-IUS), congenital anomalies were reported in 2 infants (6%).
Fetal exposure to LNG-IUS is associated with a low frequency of congenital anomalies.
Contraception 05/2009; 79(4):323-7. · 2.72 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models.
From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radio frequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure. Treatment failure was defined as hysterectomy or reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes.
The amenorrhea rate was 23% (95% confidence interval [CI] 19-28%) and the 5-year cumulative failure rate was 16% (95% CI 10-20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR] 2.6, 95% CI 1.6-4.3); uterine length less than 9 cm (aOR 1.8, 95% CI 1.1-3.1); endometrial thickness less than 4 mm (aOR 2.7, 95% CI 1.2-6.3); and use of radio-frequency ablation instead of thermal balloon ablation (aOR 2.8, 95% CI 1.7-4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR] 2.6, 95% CI 1.3-5.1); parity of 5 or greater (aHR 6.0, 95% CI 2.5-14.8); prior tubal ligation (aHR 2.2, 95% CI 1.2-4.0); and history of dysmenorrhea (aHR 3.7, 95% CI 1.6-8.5). After global endometrial ablation, 23 women (5.1%, 95% CI 3.2-7.5%) had pelvic pain, three (0.7%, 95% CI 0.1-1.9%) were pregnant, and none (95% CI 0-0.8%) had endometrial cancer.
Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal preprocedural patient counseling.
II.
Obstetrics and Gynecology 02/2009; 113(1):97-106. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the feasibility and effectiveness of hysteroscopic sterilization as a minimally invasive sterilization method for women with high-risk cardiac disease.
In a retrospective cohort study, 18 women with high-risk cardiac conditions that strictly contraindicated pregnancy were compared with a reference cohort of 157 women without cardiac disease. All underwent microinsert hysteroscopic sterilization at Mayo Clinic from January 2003 through February 2007. End points included successful placement, fallopian tube patency determined by hysterosalpingogram 3 months after the procedure, and pregnancy status.
Women in the cardiac cohort were younger than those in the reference cohort (median age, 25 vs 39 years; P<.001), had lower parity (median, 0 vs 2; P<.001), and had a higher proportion of patients categorized as American Society of Anesthesiologists' physical status 3 (severe systemic disease) and physical status 4 (systemic disease that is a constant threat to life) (83% vs 6%; P<.001). No significant differences were noted for use of general anesthesia (17% vs 27%; P=.41), successful bilateral device placement (100% vs 95%; P>.99), postoperative pain score (median, 0 for both groups; P=.87), or length of hospitalization (median, 6 vs 6 hours; P=.63). No intraoperative complications occurred. Follow-up hysterosalpingography showed high tubal occlusion rates in both cohorts (100% cardiac; 98% reference; P>.99). No pregnancies occurred during a median follow-up period of 20 months (interquartile range, 8-33 months).
For women with cardiac disease and strict contraindications for pregnancy, microinsert hysteroscopic sterilization provided minimally invasive, permanent, and reliable contraception.
Mayo Clinic Proceedings 05/2008; 83(4):431-8. · 5.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy of global endometrial ablation in women with bleeding disorders who presented with menorrhagia.
A records-linkage system was used to construct a retrospective cohort of 41 women with bleeding disorders (coagulopathy) and a reference group of 111 randomly selected women without bleeding disorders from a pool of 943 women who underwent global endometrial ablation (with thermal balloon ablation technology or bipolar radiofrequency ablation technology) for menorrhagia at Mayo Clinic (Rochester, Minnesota) from January 1995 through December 2005. Demographic data, type of global endometrial ablation therapy and reablation, and hysterectomy data were extracted from the database.
There was no significant difference in baseline age, parity, body mass index, uterine size, type of global endometrial ablation therapy, or duration of follow-up between the groups. Two women (5%) in the coagulopathy group had hysterectomy or reablation, compared with 8 (7%) in the reference group (Fisher exact test, P=.728). A Kaplan-Meier plot showed no difference in the time to treatment failure between the groups (log-rank test, P=.534). Procedural-related complications were generally minor and infrequent (9 of 152 [6%]). Complications were equally distributed in the coagulopathy (4 of 41) and reference groups (6 of 111) (Fisher exact test, P=.267).
Global endometrial ablation is an effective treatment choice for women with coagulopathy presenting with menorrhagia.
Obstetrics and Gynecology 07/2007; 109(6):1381-7. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: The Essure microinsert is a new U.S. Food and Drug Administration-approved method of birth control. The objective of this study is to report our initial experience using hysterosalpingography (HSG) to assess its efficacy for permanent tubal occlusion. CONCLUSION: The Essure microinsert produced tubal blockage in all patients. As this device may become more widely used, radiologists should be aware of the device's appearance and be able to assess device position and presence of tubal occlusion on HSG.
American Journal of Roentgenology 11/2006; 187(4):955-8. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: The purpose of this article is to describe the appearance and location of the Essure permanent birth control device on sonography, CT, and MRI. CONCLUSION: The Essure device has a distinct appearance and typical location that allow it to be accurately identified on sonography, CT, and MRI scans.
American Journal of Roentgenology 11/2006; 187(4):959-64. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 50-year-old woman was referred for evaluation with an 8-month history of intermittent malodorous vaginal discharge initially noted 2 months after placement of a transobturator tape for stress urinary incontinence. Evaluation revealed erosion of the tape through the vaginal wall with a sinus tract associated with an ischiorectal abscess. Surgical removal of the tape with excision of the sinus tract, drain placement, and antibiotic therapy was needed for complete resolution of the symptoms. Infectious complications need to be considered when counseling women prior to synthetic sling placement. A high index of suspicion, meticulous sub- and periurethral inspection, along with aggressive surgical management are required to treat an infected draining abscess following synthetic transobturator sling placement.
International Urogynecology Journal 07/2006; 17(4):418-21. · 1.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the feasibility of performing Essure hysteroscopic sterilization immediately after NovaSure global endometrial ablation (GEA).
Descriptive feasibility study (Canadian Task Force classification III).
Midwestern United States academic medical center.
Twenty-five women (aged 35-49 years) with menorrhagia who elected GEA treatment and requested concurrent permanent sterilization.
NovaSure GEA followed immediately by Essure hysteroscopic sterilization. Patients returned 3 months after the procedure for hysterosalpingography (HSG) to document tubal occlusion.
The inserts were placed successfully in all 25 patients; 21 returned for 3-month follow-up HSG, as recommended. Bilateral tubal occlusion was documented at 3 months in 19 patients (90%) and unilateral occlusion in 2 patients. Six-month postprocedural HSG in these 2 patients documented bilateral tubal occlusion. Hysterosalpingography was not performed in 4 patients. In all 21 patients with appropriate follow-up, complete occlusion was documented, and the ability to perform or interpret HSG was not affected by endometrial ablation.
Essure hysteroscopic sterilization can be safely performed after NovaSure GEA. Intrauterine synechiae do not appear to adversely affect the ability to perform HSG at 3 months or to document tubal occlusion.
Journal of Minimally Invasive Gynecology 14(4):494-501. · 1.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation.
Retrospective cohort study (Canadian Task Force classification II-2).
Midwestern academic medical center.
Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied.
Placement of the Essure inserts according to the manufacturer's instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy.
Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was 180 dollars (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p <.0001), but this was offset by higher charges for operating room costs, which included the recovery room (p <.0001) and pharmacy costs (p <.0001) in the patients in the laparoscopy group.
In our setting, the Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study.
Journal of Minimally Invasive Gynecology 14(1):97-102. · 1.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the efficacy of bipolar radiofrequency ablation (RFA) and thermal balloon ablation (TBA) using treatment failure and postprocedure amenorrhea as outcome measures.
Population-based cohort study (Canadian Task Force classification II-2).
Two medical centers in the upper Midwest.
Using the medical records linkage system of the Rochester Epidemiology Project, we identified 455 residents of Olmsted County, Minnesota, who underwent global endometrial ablation because of menorrhagia from January 1, 1998, through December 31, 2005. Amenorrhea was defined as complete cessation of menstruation that started immediately after ablation and lasted at least 12 months. Treatment failure was defined as necessity of repeat ablation or hysterectomy because of persistent bleeding or pain. Time to treatment failure for each procedure was compared using Kaplan-Meier plots. Relevant clinical data and complications were abstracted from medical records. Risk adjustments were performed using Cox and logistic regression models.
Radiofrequency ablation (n=255) and thermal balloon ablation (n=200).
Mean (SD) patient age was 43.3 (5.5) years, and median follow-up was 2.2 years. The 3-year cumulative failure rate was 9% (95% confidence interval [CI], 5%-16%) for RFA and 12% (95% CI, 7%-16%) for TBA (p=.26). The difference remained nonsignificant after adjusting for known predictors of treatment failure such as age, parity, pretreatment dysmenorrhea, and tubal ligation (adjusted HR, 0.7; 95% CI, 0.4-1.4; p=.31). However, women had significantly higher rates of amenorrhea after RFA compared with TBA (32% vs 14%; p <.001). This difference remained significant after adjusting for known predictors of amenorrhea such as age, uterine length, and endometrial thickness (adjusted odds ratio, 2.9; 95% CI, 1.7-4.8; p <.001). Complications were infrequent and similar in the 2 groups.
Both RFA and TBA were equally effective treatments for menorrhagia in a population-based cohort. However, women who underwent RFA were 3 times more likely to have postprocedure amenorrhea.
Journal of Minimally Invasive Gynecology 16(6):692-9. · 1.74 Impact Factor
