Indian Journal of Obstetrics and Gynecology Research


TREATMENT ANALYSIS OF TRANSCERVICAL RESECTION OF ENDOMETRIUM (TCRE) IN HEAVY MENSTRUAL BLEEDING (HMB): A PROSPECTIVE MULTICENTRE THERAUPETIC STUDY IN INDIAN SCENARIO


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Author Details: Neha Palo Chandel, Vidya V Bhat, R S Bhat, Sidharth S Chandel

Volume : 2

Issue : 1

Online ISSN : 2394-2754

Print ISSN : 2394-2746

Article First Page : 28

Article End Page : 35


Abstract

Introduction: Heavy Menstrual Bleeding is a major factor affecting the quality of life and work performance in the perimenopausal women. In a country like India, especially in the rural settings, females hesitate to report to clinicians for gynecological problems like HMB, which affect their life significantly. And even if they do report, they are made to undergo unnecessary hysterectomies, despite there being alternative methods to manage such conditions.

Methods: We initiated a prospective therapeutic study from July 2012 to July 2014, where we screened 2106 patients with menorrhagia to study the role of TCRE in these patients, 179 patients fulfilled the inclusion criteria, gave consent and were operated with TCRE to study its outcomes. These patients were cases of Mirena failure or those not willing for Mirena, histopathological diagnosis of simple hyperplasia as well as cystoglandular hyperplasia and especially the poor-follow up cases and rural patients with HMB.
Results: TCRE has success rate of 85.5% as assessed by the patients’ satisfaction after the procedure and improvement in their bleeding pattern.11.2% reported with recurrence of menorrhagia, out of which 7.3% received exogenous progesterone therapy later, and were relieved with it, while 3.9% underwent a hysterectomy as the last resort. Haematometra was observed post–operatively in 3 cases(1.7%), Fluid overload was observed in 2 cases(1.1%) and ‘False- passage’ was encountered in 1 case (0.5%), where the procedure was abandoned and was performed after a month.
Conclusion: Hysteroscopic TCRE is an effective modality, avoids unnecessary hysterectomy in the perimenopausal women and allows early return to work. The cost-effectiveness, improved quality of life and work performance provides TCRE an edge over the ‘conventional’ hysterectomy.

Keywords: TCRE, Heavy menstrual bleed, Hysteroscopy, Menorrhagia, Screening, DUB.