Has endometrial ablation replaced hysterectomy for the treatment of dysfunctional uterine bleeding? National figures

OBJECTIVES: To describe trends in the use of endometrial ablation and hysterectomy for the treatment of dysfunctional uterine bleeding. DESIGN: Analysis of hospital admissions data. SETTING: National Health Service Hospitals in England. POPULATION: Women who underwent a hysterectomy or endometrial ablation for dysfunctional uterine bleeding between 1989 and 1996. MAIN OUTCOME MEASURES: Annual operation rates and standardised operation ratios for England and for the National Health Service Regions within it, and proportion of operations for dysfunctional uterine bleeding that were endometrial ablations or hysterectomies. RESULTS: There was an initial rise in operation rates for endometrial ablation until 1992/3, since when the rates have fallen. Hysterectomy rates have remained relatively steady since the introduction of endometrial ablation. The total operation rates for dysfunctional uterine bleeding initially increased but have tended to fall since 1992/3. The ratio of hysterectomy to endometrial ablation for dysfunctional uterine bleeding troughed at 3:1 in 1992/3, but by 1995/6 had increased to 4:1. CONCLUSIONS: Rather than replacing hysterectomy in the treatment of dysfunctional uterine bleeding, endometrial ablation appears to have added an alternative operative technique. This led to an increase in the total number of operations for this condition, perhaps by lowering the threshold for intervention.