A prospective study for a combined hysteroscopic local hormonal therapy of recurrent refractory hypermenorrhoeas

In a prospective non-randomised study 26 patients suffering from refractory recurrent hypermenorrhoea had been treated by hysteroscopic endometrial ablation. Insertion of levonorgestrel-IUD was performed postoperative in 13 patients. The purpose of the insertion was intrauterine contraception, increase of the postoperative rate of amenorrhoea, and prevention of an obliteration of the uterine cavity. An increased rate of amenorrhoea (92% vs. 54%) could be reached in comparison to a control group of patients who were treated by endometrial ablation only. Simultaneous laparoscopic tubal sterilisation could be avoided by inserting the IUD. These are the two main advantages of postoperative insertion of a levonorgestrel-IUD with long-term action. This possibility of simultaneous contraception during endometrial ablation is recommended. Further studies are necessary to detect long-term results and a possible third positive postoperative effect (prevention of post-ablation syndromes).