You exist when Women lose more than 80 milliliters of blood during menstruation or their menstrual period lasts for more than seven days. The German Institute for Quality and Efficiency in Health Care (IQWiG) compared the benefits of different methods for their treatment.
Causes of excessive and prolonged menstrual bleeding (menorrhagia) – one of the most common menstrual cramps – can be benign tissue formations in the muscle tissue of the uterine wall (myomas), polyps or endometriosis. However, the cause is often unknown.
Radiofrequency ablation
In a “high-frequency ablation with a mesh electrode”, the lining of the uterus (endometrium) of patients with menorrhagia is obliterated and removed by high-frequency electricity. This is supposed to relieve the excessive menstrual bleeding. This examines the advantages and disadvantages of such a treatment compared to other methods commonly used in Germany for the removal (ablation) of the uterine lining – loop resection and balloon ablation IQWiG currently in a benefit assessment. According to the preliminary results of the preliminary report, high-frequency ablation can alleviate some stressful menstrual symptoms more effectively than the comparison methods.
Relieving symptoms and ailments is crucial
If medication does not provide adequate relief from menstrual bleeding or if something speaks against the available medication, surgery is an option for women with menorrhagia – if they do not wish to have children. Then either the entire uterus is removed or only the uterine lining is removed (ablation).
Removal of the mucous membrane
The loop resection is the first generation ablation procedure, which is often combined with rollerball ablation and is usually checked endoscopically. The lining of the uterus is removed with surgical instruments. The high-frequency ablation with a mesh electrode and the ablation with a hot water balloon (balloon ablation) are considered to be 2nd generation procedures and are usually carried out without endoscopic control.
Advantages of high frequency ablation compared to loop resection
In two studies, the effect of high-frequency ablation is compared with that of a loop resection. Despite a certain uncertainty regarding the allocation of the patients to the treatment groups, the advantages of high-frequency ablation become clear in important aspects: undesirable effects, in particular complications during the procedure, occurred less often and period pain could also be eliminated more frequently with high-frequency ablation than with a loop resection with rollerball ablation . Both procedures reduce the intensity of menstrual bleeding equally well.
The studies do not provide any data for other aspects such as health-related quality of life.
Benefits of radiofrequency ablation, premenstrual syndrome
Four studies provide data for the comparison of high-frequency ablation with balloon ablation and consistently show that the bleeding intensity decreases significantly after high-frequency ablation.
A premenstrual syndrome, understood as complex physical and emotional complaints in connection with the menstrual cycle, is therefore comparatively less pronounced after high-frequency ablation.
Other aspects not shown
For other aspects such as menstrual pain, depressive symptoms, postoperative pain, repeated interventions, adverse events or health-related quality of life, the high-frequency ablation showed no greater or harm. Overall, the IQWiG comes to an indication of a greater benefit of high-frequency ablation compared to balloon ablation.
IQWiG / Mag. Christian Boukal
August 2021
Image: goffkein.pro/shutterstock.com
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