Human Reproduction, Vol. 15, No. 6, 1424-1425,
June 2000
© 2000 European Society of Human Reproduction and Embryology
Letters to the Editor |
Thermal balloon ablation versus endometrial resection for treatment of abnormal uterine bleeding
Department of Obstetrics and Gynaecology, St Joseph Hospital, PO Box 7777, 5500 MB Veldhoven, The Netherlands, E-mail: bonger{at}iaehv.nl
Dear Sir,
Gervaise and colleagues recently reported on a comparison of thermal balloon ablation versus endometrial resection for the treatment of abnormal uterine bleeding (Gervaise et al., 1999
). We have some concerns about their methods.
Taking into account the non-randomized character of their study, it is of importance to know the indications for both interventions under study. While excessive menstrual blood loss was the indication for treatment, nothing is mentioned on the indication for either balloon ablation or endometrial resection. This is worrisome, since the authors fail to take into account pre-operative bleeding patterns in the comparison of baseline characteristics. The imbalance in menopausal status indicates that the two groups are not comparable as the authors want us to believe.
Another concern is that for no obvious reason, patients in the balloon group have been contacted three times at follow-up, whereas patients in the resection group have been contacted only once. Given the single follow-up moment, it remains unclear how `time to failure' is registered in the resection group.
A third point of concern is the definition of end-points. In the absence of measurement of patients' quality of life or patients' valuation of treatment effect, the authors use amenorrhoea and hypomenorrhoea as measure of success. Although significant differences are not reported, the percentages of amenorrhoea and hypomenorrhoea are lower after balloon ablation as compared to endometrial resection. Combination of these two endpoints leads to a relative risk of 0.68 in favour of endometrial resection (95% confidence limits 0.51 to 0.90). On the disappearance of dysmenorrheoa, announced as a secondary end-point in the methods, no results are reported at all. Taking into account these concerns, we feel that the data provided in the study of Gervaise et al. (1999) do not allow the conclusion of the authors that uterine balloon ablation appears to be as efficacious as endometrial resection for the treatment of abnormal uterine bleeding.
Notes
1 To whom correspondence should be addressed 
References
Gervaise, A., Fernandez, H., Capella-Allouc, S. et al. (1999) Thermal balloon ablation versus endomterial resection for the treatment of abnormal uterine bleeding. Hum. Reprod., 14, 2743–2747.
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