Combined transcervical endometrial resection and levonorgestrel device treatment compared to transcervical endometrial resection for abnormal uterine bleed.

INTRODUCTION Transcervical resection of the endometrium (TCRE) is a first line surgical treatment of abnormal uterine bleeding. However, many patients experience unsuccessful results, causing hysterectomy in up 17% of cases. The aim of this study was to describe the odds of hysterectomy in patients with abnormal uterine bleeding, treated with TCRE and Levonorgestrel intrauterine device (TCRE+LNG-IUD) or TCRE alone. The secondary aim was to analyze the rate of amenorrhea. MATERIAL AND METHODS Designed as a retrospective cohort study, and conducted at Odense University Hospital, Denmark, the study included women with abnormal uterine bleeding, who underwent TCRE from January 2013 to December 2015. The decision of treatment with respect to LNG-IUD was at the patient's discretion. Data was collected from medical records and a self-reported retrospective bleeding-pattern questionnaire. A multivariate regression model was used, enabling adjustment for potential and identified confounders. RESULTS Out of 432 women, 276 (62 %) consented to inclusion and of these 16 (4%) were excluded. In total 88 (34 %) received combined treatment and 172 (66 %) TCRE alone. Ten women (11 %) treated with TCRE+LNG underwent hysterectomy, compared to 27 (16 %) treated with TCRE alone (OR=0.69, CI 0.28-1.56; P=0.34.). Multivariate analysis disclosed a significant effect of TCRE+LNG-IUD (OR=0.35, CI 0.13-0.97; P=0.04.) on hysterectomy. The presence of fibromas was shown to increase the odds treatment failure, resulting in hysterectomy (OR 2.69, CI 1.15-6.31; P=0.02). Furthermore, the incidence of amenorrhea was 59 % in TCRE+LNG group and 36 % in TCRE group (OR=2.56, CI 1.46-4.49; P < 0.01). CONCLUSIONS The study showed significantly lower odds of hysterectomy in the TCRE+LNG-IUD group when adjusted for confounders. Combination treatment improves the bleeding patterns significantly compared to monotherapy with TCRE.