The alternatives to hysterectomy

Hysterectomy is one of the commonest major operations, with 72 362 procedures performed in England in 1993. However, for women with dysfunctional uterine bleeding other less invasive surgical options have been developed. In particular, hysteroscopic endometrial ablation has been shown to be an effective therapy. Prospective randomized trials have shown that hysteroscopic surgery is associated with a shorter operating time, fewer complications, less analgesic requirement, a faster resumption of normal activities and work and savings in treatment costs. Psychological and social functioning also improves with no significant differences compared to hysterectomy. There is, however, a tendency for women randomized to hysterectomy to report higher rates of satisfaction. Several non-hysteroscopic ablative techniques are currently being developed and tested. While attractive, as they do not require significant hysteroscopic skills and will probably prove to have fewer operative risks than hysteroscopic procedures, the results of these procedures are still in the evaluation phase.