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Type: Journal article
Title: Second generation endometrial ablation techniques for heavy menstrual bleeding: network meta-analysis
Author: Daniels, J.
Middleton, L.
Champaneria, R.
Khan, K.
Cooper, K.
Mol, B.
Bhattacharya, S.
Citation: BMJ, 2012; 344(apr23 1):e2564-1-e2564-12
Publisher: BMJ Group
Issue Date: 2012
ISSN: 1756-1833
Statement of
J P Daniels, L J Middleton, R Champaneria, K S Khan, K Cooper, B W J Mol, S Bhattacharya on behalf of the International Heavy Menstrual Bleeding IPD Meta-analysis Collaborative Group
Abstract: Objective To determine the relative effectiveness of second generation ablation techniques in the treatment of heavy menstrual bleeding. Design Network meta-analysis on the primary outcome measures of amenorrhoea, heavy bleeding, and patients’ dissatisfaction with treatment. Data sources Nineteen randomised controlled trials (involving 3287 women) were identified through electronic searches of the Cochrane Library, Medline, Embase and PsycINFO databases from inception to April 2011. The reference lists of known relevant articles were searched for further articles. Two reviewers independently selected articles without language restrictions. Eligibility criteria for selecting studies Randomised controlled trials involving second generation endometrial destruction techniques for women with heavy menstrual bleeding unresponsive to medical treatment. Results Of the three most commonly used techniques, network meta-analysis showed that bipolar radiofrequency and microwave ablation resulted in higher rates of amenorrhoea than thermal balloon ablation at around 12 months (odds ratio 2.51, 95% confidence interval 1.53 to 4.12, P<0.001; and 1.66, 1.01 to 2.71, P=0.05, respectively), but there was no evidence of a convincing difference between the three techniques in the number of women dissatisfied with treatment or still experiencing heavy bleeding. Compared with bipolar radio frequency and microwave devices, an increased number of women still experienced heavy bleeding after free fluid ablation (2.19, 1.07 to 4.50, P=0.03; and 2.91, 1.23 to 6.88, P=0.02, respectively). Compared with radio frequency ablation, free fluid ablation was associated with reduced rates of amenorrhoea (0.36, 0.19 to 0.67, P=0.004) and increased rates of dissatisfaction (4.79, 1.07 to 21.5, P=0.04). Of the less commonly used devices, endometrial laser intrauterine thermotherapy was associated with increased rates of amenorrhoea compared with all the other devices, while cryoablation led to a reduced rate compared with bipolar radio frequency and microwave. Conclusions Bipolar radio frequency and microwave ablative devices are more effective than thermal balloon and free fluid ablation in the treatment of heavy menstrual bleeding with second generation endometrial ablation devices.
Keywords: International Heavy Menstrual Bleeding IPD Meta-analysis Collaborative Group; Endometrium; Humans; Menorrhagia; Catheter Ablation; Hysteroscopy; Treatment Outcome; Cryosurgery; Laser Coagulation; Confidence Intervals; Odds Ratio; Algorithms; Microwaves; Patient Satisfaction; Female; Randomized Controlled Trials as Topic; Endometrial Ablation Techniques
Rights: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and
RMID: 0020136926
DOI: 10.1136/bmj.e2564
Appears in Collections:Obstetrics and Gynaecology publications

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