Hysteroscopic management of menstrual disorders: A review of 395 patients

Objective: To evaluate the long-term effectiveness of transcervical resections in menstrual disorders. Design: Retrospective consecutive patient follow-up. Patients: From 1987 to 1993, 395 patients with menstrual disorders (menorrhagia and/or metrorrhagia) were treated with operative hysteroscopy in our department. Resection of endometrial polyps was performed in 65 cases, resection of submucous fibroids in 196, and endometrial ablation in 134. Fourty-one patients had a repeat procedure. Results: Our mean follow-up period was 2.7 years. Thirteen complications were noted (3%), two of which were serious (one hemoperitoneum after uterine perforation, one severe symptomatic hyponatremia). Twenty-eight patients did not remain in contact after hospitalization (7.1%). Menstrual disorders were controlled in 297 patients (75.2%). Failure was noted in 70 patients (17.7%), including hysterectomy in 50 patients and persistent bleeding in 20. Conclusion: Hysteroscopic surgery is a satisfying technique for women with abnormal uterine bleeding who want a conservation of the uterus. Better results are noted with resections of polyps and fibroids than with endometrial ablations.