Cochrane · systematic review · CD000329
Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding
Bofill Rodriguez, M, Lethaby, A, Fergusson, RJ · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
19
current version
GRADE rated
18
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 1 · 5.3%Very low 0 · 0%Low 6 · 31.6%Moderate 12 · 63.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyEndometrial resection or ablation compared to open hysterectomy for heavy menstrual bleeding
Population: HMB
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Effectiveness Woman's perception (proportion with improvement in bleeding symptoms) Endometrial resection or ablation vs open hysterectomy | RR 0.9 [0.84, 0.95] | 2 studies · 247 participants | Moderate Downgraded: risk of bias |
Quality of life SF‐36 at 2 years – general health perception Endometrial resection or ablation vs open hysterectomy | no estimate extracted | 1 study · 155 participants | Moderate Downgraded: risk of bias |
Requirement for further surgery for treatment failure within 1 year after surgery Endometrial resection or ablation vs open hysterectomy | no estimate extracted | 2 studies · 247 participants | Moderate Downgraded: risk of bias |
Acceptability Proportion satisfied with treatment Endometrial resection or ablation vs open hysterectomy | RR 0.91 [0.82, 1] | 1 study · 194 participants | Moderate Downgraded: risk of bias |
Safety Any serious adverse events Endometrial resection or ablation vs open hysterectomy | RR 1.29 [0.32, 5.2] | 2 studies · 247 participants | Low Downgraded: risk of bias, inconsistency |
Time to return to normal activity Endometrial resection or ablation vs open hysterectomy | no estimate extracted | 1 study · 194 participants | Moderate Downgraded: risk of bias |
Endometrial resection or ablation versus minimally invasive hysterectomy for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Effectiveness Endometrial resection or ablation vs minimally invasive hysterectomy | RR 0.97 [0.9, 1.04] | 1 study · 79 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Endometrial resection or ablation vs minimally invasive hysterectomy | no estimate extracted | 2 studies · 145 participants | Moderate Downgraded: risk of bias |
Requirement for further surgery for treatment failure within 1 year after surgery Endometrial resection or ablation vs minimally invasive hysterectomy | RR 7.7 [2.54, 23.32] | 4 studies · 922 participants | Moderate Downgraded: risk of bias |
Acceptability Proportion satisfied with treatment Endometrial resection or ablation vs minimally invasive hysterectomy | RR 0.9 [0.85, 0.94] | 1 study · 558 participants | Moderate Downgraded: risk of bias |
Safety Any serious adverse event Endometrial resection or ablation vs minimally invasive hysterectomy | RR 0.75 [0.35, 1.59] | 4 studies · 809 participants | Moderate Downgraded: risk of bias |
Time to return to normal activity Endometrial resection or ablation vs minimally invasive hysterectomy | no estimate extracted | 99 participants | Ungraded |
Endometrial resection/ablation versus unspecified (or at surgeon's discretion) route of hysterectomy for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Effectiveness Proportion of women with perception of improvement of bleeding symptoms Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | RR 0.89 [0.83, 0.95] | 2 studies · 403 participants | Low Downgraded: risk of bias, inconsistency |
Quality of life SF‐36 general health perception Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | no estimate extracted | 1 study · 209 participants | Low Downgraded: risk of bias, inconsistency |
Proportion with improvement in general health Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | RR 0.85 [0.77, 0.95] | 1 study · 185 participants | Low Downgraded: risk of bias, inconsistency |
Requirement for further surgery for treatment failure Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | no estimate extracted | 2 studies · 374 participants | Moderate Downgraded: risk of bias |
Acceptability Proportion satisfied with treatment Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | RR 0.96 [0.88, 1.04] | 3 studies · 545 participants | Moderate Downgraded: risk of bias |
Safety Any serious adverse event Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | RR 0.21 [0.06, 0.8] | 2 studies · 374 participants | Moderate Downgraded: risk of bias |
Time to return to normal activity Endometrial resection/ablation vs unspecified (or at surgeon's discretion) route of hysterectomy | no estimate extracted | 1 study · 172 participants | Low Downgraded: risk of bias, inconsistency |
Endometrial resection or ablation compared to hysterectomy for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Woman's perception (proportion with improvement in bleeding symptoms) ‐ within 1 year of Endometrial resection or ablation vs hysterectomy | RR 0.89 [0.85, 0.93] | 4 studies · 650 participants | Low Downgraded: risk of bias |
PBAC score (continuous data) ‐ at 1 year of Endometrial resection or ablation vs hysterectomy | no estimate extracted | 1 study · 68 participants | Moderate Downgraded: risk of bias |
Proportion requiring further surgery for HMB ‐ within 1 year after surgery Endometrial resection or ablation vs hysterectomy | RR 16.17 [5.53, 47.24] | 7 studies · 927 participants | Low Downgraded: risk of bias |
Proportion satisfied with treatment ‐ at 1 year of Endometrial resection or ablation vs hysterectomy | RR 0.94 [0.88, 1] | 4 studies · 739 participants | Moderate Downgraded: risk of bias |
Adverse events—short term (intraoperative and immediate postoperative) ‐ Sepsis Endometrial resection or ablation vs hysterectomy | RR 0.19 [0.12, 0.31] | 4 studies · 621 participants | Low Downgraded: risk of bias |
Endometrial resection/ablation for heavy menstrual bleeding
Population: women with heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Woman's perception (proportion with improvement in bleeding symptoms)—within one year of | RR 0.91 [0.8, 0.97] | 4 studies · 650 participants | Low Downgraded: risk of bias, inconsistency |
PBAC score (continuous data)—at one year of | no estimate extracted | 1 study · 68 participants | Moderate Downgraded: risk of bias |
Adverse events—short term (intraoperative and immediate postoperative)—sepsis | RR 0.19 [0.12, 0.31] | 4 studies · 621 participants | Moderate Downgraded: inconsistency |
Proportion requiring further surgery for HMB—within one year after surgery | RR 14.94 [5.24, 42.57] | 6 studies · 887 participants | Low Downgraded: risk of bias |
Proportion satisfied with treatment—at one year of | RR 0.94 [0.88, 1] | 4 studies · 739 participants | Moderate Downgraded: risk of bias |
Endometrial resection versus hysterectomy for heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in unspecified symptoms within 1 year within 2 years within 3 years within 4 years Endometrial resection vs hysterectomy | no estimate extracted | 2 studies · 395 participants | Ungraded |
Improvement in bleeding symptoms Within 1 year Within 2 years Within 4 years Endometrial resection vs hysterectomy | no estimate extracted | 3 studies · 440 participants | Ungraded |
Satisfaction with treatment Within 1 year Within 2 years Within 3 years Within 4 years Endometrial resection vs hysterectomy | no estimate extracted | 4 studies · 739 participants | Ungraded |
Time to return to normal activity (days) Endometrial resection vs hysterectomy | no estimate extracted | 4 studies · 632 participants | Ungraded |
Adverse event (sepsis) Endometrial resection vs hysterectomy | no estimate extracted | 4 studies · 621 participants | Ungraded |
Requirement for further surgery Within 1 year Within 2 years Within 3 years Within 4 years Endometrial resection vs hysterectomy | no estimate extracted | 6 studies · 887 participants | Ungraded |