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Endometrial ablation may not prevent hysterectomy for many women with benign uterine conditions

In 1980, endometrial ablation was introduced as an alternative to hysterectomy for abnormal uterine bleeding. Its aim is to alleviate excessive menstrual bleeding in premenopausal women by destroying or removing the endometrial lining while conserving the uterus. There is a group of women who will benefit from this typically 1-day outpatient procedure and avoid hysterectomy. However, this procedure seems to be used in addition to rather than instead of hysterectomy for benign uterine conditions such as abnormal uterine bleeding, according to a study by researchers at the Agency for Healthcare Research and Quality.

Cynthia M. Farquhar, M.D., Sandra Naoom, B.Psych., and Claudia A. Steiner, M.D., M.P.H., accessed data on women with benign uterine conditions who underwent either hysterectomy or endometrial ablation using the State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for six States from 1990 to 1997. In the six States studied, endometrial ablation was used as an additive medical technology rather than as a substitute for hysterectomy.

The proportionate increases in endometrial ablation did not mirror proportionate decreases in hysterectomy in any of the six States studied. Hysterectomy rates either declined slightly or remained unchanged. Yet, the rate for endometrial ablation for women with benign uterine conditions for all States increased significantly. The analysis included women who may have had more than one procedure, with hysterectomies perhaps following failed ablations. The researchers suggest implementing strategies to reduce hysterectomy rates in favor of endometrial ablation as well as other nonsurgical interventions tried in other countries.

See "The impact of endometrial ablation on hysterectomy rates in women with benign uterine conditions in the United States," by Drs. Farquhar, Naoom, and Steiner, in the International Journal of Technology Assessment in Health Care 18(3), pp. 625-634, 2002.

Reprints (AHRQ Publication No. 03-R004) are available from the AHRQ Publications Clearinghouse.

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