New attempt using ablative curettage technique for managing benign premenopausal uterine bleeding.

Aim: To assess the efficacy of a newly suggested ablative curettage technique in managing premenopausal dysfunctional uterine bleeding.

Methods: A prospective controlled operative study and clinical trial was carried out at the Department of Obstetrics and Gynecology, Kasr El-Aini Hospital, Cairo University, Egypt. One hundred cases of premenopausal bleeding were divided into 50 controls and 50 studied cases. Routine diagnostic and follow-up techniques for managing premenopausal bleeding were carried out. Two operative techniques were compared: overcurettage, using Sims sharp curette, and the newly suggested dilatation and ablative curettage, using a Thabet double-bladed sharp curette. Histopathology of curetted material and the endomyometrium after ablation in the failed cases that needed hysterectomy was also included.

Results: Successful endometrial ablation and control of the premenopausal bleeding were recorded in 66% of overcurettage cases and in 90% of cases treated with ablative curettage. The latter had significantly fewer operative and postoperative complications. These advantages were also significantly reduced in both techniques compared with other ablative techniques and hysterectomy. Complete ablation could be confirmed histopathologically in the ablated endometrium and in the endomyometrium of the hysterectomy specimens.

Conclusion: Ablative curettage is an efficient technique in managing premenopausal dysfunctional uterine bleeding, especially in developing countries where there are limited financial resources.