Medium-term follow-up of women with menorrhagia treated by rollerball endometrial ablation

Objective: To assess the medium-term efficacy of rollerball endometrial ablation. Methods: From January 1990 to December 1993, 142 women underwent rollerball endometrial ablation for menorrhagia, most with ovulatory dysfunctional uterine bleeding. Each was sent a detailed questionnaire 12-52 months later and then followed-up, with an overall 93% response rate. Thirty-two had uterine myomas (13 with hysteroscopic myoma resection) and 11 had a large endometrial polyp (four with both). Most of the women were pretreated with danazol. Results: Thirty-two of 128 (25%) achieved long-term, complete amenorrhea and only three eventually resumed their periods after prolonged amenorrhea. Four women experienced late amenorrhea, which was probably due to menopause. The percentage of satisfactory outcomes decreased gradually with time (95.5, 85.5, and 75% for 13-24, 25-36 and more than 36 months respectively; P = .051); this was not statistically significant. One hundred twenty-one patients (85.2%) did not need further surgical treatment. The incidence of repeat ablation (8.5%) and hysterectomy (8.5%) increased gradually with time over the first 3 years but not thereafter, although total numbers are still small. Cyclic pelvic pain and premenstrual symptoms were much improved in both short and long term. Most women remained satisfied with the operation (84%) and would recommend it to others (89%). Conclusion: Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the management of intractable menorrhagia due to ovulatory dysfunctional uterine bleeding. However, with the findings of slightly less satisfactory results with time, longer-term follow-up is still needed to establish the ultimate effectiveness of the procedure using different techniques.