WOMEN : ABNORMAL MENSTRUAL BLEEDING RESPONDS TO ALTERNATIVE SURGERY.

Byline: Denise Mann Medical Tribune News Service

Women who have unusually heavy or prolonged menstrual bleeding often undergo a hysterectomy to eliminate the bleeding.

But in a new study of 525 premenopausal women with the condition, researchers have found that a less radical surgical technique that removes only the uterine lining - rather than the entire uterus as with hysterectomy - is highly effective at decreasing the abnormal bleeding.

Up to five years after undergoing the newer surgery, known as endometrial ablation, 85 percent to 100 percent of the women reported that their abnormal bleeding had abated, reported researcher Dr. Adam Magos of the University Department of Obstetrics and Gynecology at Royal Free Hospital in London, England.

The new report published in the New England Journal of Medicine is the first study to show the long-term benefits of endometrial ablation, according to the researchers.

Abnormally heavy menstrual flow, or menorrhagia, can be caused by a hormone imbalance or benign tumors in the uterus. The condition usually affects premenopausal women and can be treated with long-term hormone therapy, a hysterectomy or endometrial ablation.

Widely used in England, endometrial ablation has not been embraced by many American surgeons who believe that these women would eventually have to undergo a hysterectomy anyway.

In the new study, however, only 9 percent of the women eventually underwent a hysterectomy.

Doctors perform endometrial ablation by inserting a thin tube through the woman's cervix and into the uterus. Then the uterine lining is removed both with cutting instruments and electrosurgical tools, which burn the lining off. Lasers also can be used to remove the lining.

``Although there is debate about the effect of endometrial ablation on the overall rates of hysterectomy, it does offer women who are reluctant to undergo hysterectomy the dual advantages of relatively conservative surgery and freedom from prolonged medical therapy,'' Magos concluded.

However, two American doctors maintain that the benefits of a hysterectomy outweigh those of endometrial ablation in the long run.

Hysterectomy eliminates bleeding entirely and ensures that a woman will remain free from uterine cancer, said Dr. Karen J. Carlson, director of the Women's Health Association at Massachusetts General Hospital in Boston, who co-authored an accompanying editorial.

``I would try medication first. If the woman couldn't or wouldn't take hormones, I would present her with her options,'' she said.

If a woman was close to menopause - where menstruation naturally ceases - then endometrial ablation may be right for her, Carlson said.

But in younger women, a hysterectomy is probably the better choice since bleeding may recur, she said.

In the new study, 26 percent to 40 percent of the women said they stopped getting their period completely. And 71 percent to 80 percent said that their cramps had subsided after undergoing the newer surgery, the researchers reported.

``Endometrial ablation serves a purpose, but in my opinion, (this procedure) is more set for a woman who has problems with anesthesia,'' said Dr. Randall M. Toig, an obstetrician and gynecologist at Northwestern Memorial Hospital in Chicago.

Endometrial ablation requires less anesthesia than a hysterectomy, and can sometimes be done while the patient is awake, said Toig, also an associate professor of obstetrics and gynecology at Northwestern University Medical School.