The effectiveness of outpatient Thermachoice endometrial balloon ablation: a long-term 11-year outcome study

The aim of this study was to evaluate the long-term treatment outcomes of outpatient Thermachoice balloon endometrial ablation under a direct local anaesthetic cervical block (LA-Thermachoice). This paper is a prospective cohort study and a postal questionnaire survey in a UK teaching hospital with the participation of 253 women with heavy menstrual bleeding (HMB) undergoing LA-Thermachoice over an 11-year period between 2001 and 2011. Treatment success was measured by postoperative bleeding patterns, improvement in dysmenorrhoea, patient satisfaction and post-procedure hysterectomy rates. LA-Thermachoice was completed in 98 % of women. The survey response rate was 78 %. The median follow-up interval was 71 months (SD 42). Seventy-nine percent of the responders reported significant improvement in HMB with 40 % amenorrhoea rate and 86 % improvement in dysmenorrhoea. Eighty-one percent felt that the benefit of procedure was maintained over a long period of time. Eighty-six percent of women were satisfied with the outcome of their procedure. The case notes of non-responders were examined to check if any had undergone hysterectomy since the LA-Thermachoice procedure. In total, only 16 % of women had a hysterectomy. This study represents the largest published series of local anaesthetic thermal endometrial ablation, reporting clinical outcomes with 11 years (median 71 months) of post-treatment follow-up. It demonstrates that the patient satisfaction with LA-Thermachoice is high, and is maintained over a long period of time after the procedure.