Clinical Updates

Cytyc Surgical Products is pleased to provide reliable clinical information concerning menorrhagia. This data may be incorporated into your practice's own patient material as needed. Check here regularly to stay abreast of the latest information in the management of menorrhagia.

New Recently Published

ACOG Practice Bulletin #81, Endometrial Ablation
Clinical Management Guidelines for Obstetrician-Gynecologists
Obstetrics and Gynecology Vol. 109, no. 5 pp 1233-1248 May 2007

Background

ACOG recently published guidelines for the use of Endometrial Ablation. Prior to this Practice Bulletin, the Endometrial Ablation usage guidance had come from the 2000 ACOG Practice Bulletin on Anovulatory Bleeding. Important points from the bulletin are listed below:

Indication:

Endometrial ablation is indicated for the treatment of menorrhagia or patient-perceived heavy menstrual bleeding in pre-menopausal women with normal endometrial cavities who have no desire for future fertility.
The presence of anemia or failure or intolerance of medical therapy are important considerations but should not be construed as prerequisites for the procedure.

Endometrial Ablation Outcomes compared with Medical Therapy:

By 5 years, only 10% of those patients randomized to medical therapy continued receiving medical treatment, whereas 77% had undergone surgery.
Patients randomized to oral medical therapy were significantly less likely to be satisfied than those undergoing ablation.

Concerns of Endometrial Malignancy Detection:

An early concern of endometrial ablation was the ability to detect endometrial carcinoma. It appears now, that in most instances, an intrauterine cavity remains, allowing egress of bleeding from retained endometrium. Thus, a delay in the diagnosis of endometrial carcinoma is unlikely.

ACOG Practice Bulletins - A Comparison

When the American College of Obstetrics and Gynecology (ACOG) published the 2000 Practice Bulletin on the Management of Anovulatory Bleeding, the use of global endometrial ablation was in it’s infancy. Since then, the rapid adoption of GEA as a safe and effective treatment for menorrhagia has led to a broader selection of patients. Although this is not a direct comparison of endometrial ablation guidelines, both publications discuss menorrhagia indications and treatment options. The chart below points out the differences in scope of each paper, the marketplace at the time of publication, medical therapy vs. surgery and indications for surgery.

	Management of Anovulatory Bleeding 2000¹	Endometrial Ablation 2007²
Scope	Diagnosis and treatment of anovulatory bleeding -Subset of AUB patients with hormonal disorder; all ages and reproductive stages addressed	Role of endometrial ablation in the management of AUB -All women with AUB who have completed childbearing
Market	Early in GEA market experience Hysterectomy and 1st generation EA dominate;	5 FDA approved GEA devices with ~1 million procedures performed to date
Medical Therapy vs. Surgery	"Women who underwent medical therapy were less likely to be satisfied" "However, because of its reduced cost and risks, medical therapy should be offered before surgical intervention unless it is otherwise contraindicated”	“Patients randomized to oral medical therapy were significantly less likely to be satisfied” “By 5 years, only 10% of those patients randomized to medical therapy continued receiving medical treatment, whereas 77% had undergone surgery”
Indications For Surgery	“Surgical therapy is indicated for women with excessive anovulatory bleeding in whom medical management has failed” “Avoidance of anemia, reduction of excessively heavy bleeding, and increased, though imperfect, predictability of bleeding are appropriate goals with medical therapy”	“Endometrial ablation is indicated for the treatment of menorrhagia or patient-perceived heavy menstrual bleeding” “The presence of anemia or failure or intolerance of medical therapy are important considerations but should not be construed as prerequisites for the procedure”

If you would like to request a reprint of the ACOG Practice Bulletins,
click here

and/or;

If you would like to read the ACOG Practice Bulletins in full, go to the Obstetrics and Gynecology website at www.greenjournal.org/content/vol109/issue5/

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