A review of 35 endometrial ablations using the Nd:YAG laser for recurrent menometrorrhagia.

Endometrial ablation with the Nd:YAG laser can be used to treat recurrent dysfunctional uterine bleeding. Two series of patients were studied. All suffered for at least 1 year with recurrent menometrorrhagia that was unresponsive to other treatments such as hormonal therapy or removal of polyps or fibroids. In the first series, 75 patients presenting with menometrorrhagia were considered for endometrial ablation using Nd:YAG laser, and 23 met conservative requirements. In the second series, 12 of the 25 patients considered met the conservative requirements. The patients in series I received danazol for 30 days before and 30 days after the procedure; patients in series II received leuprolide acetate. All patients were followed for at least 1 year after treatment was discontinued. Of the 35 patients in both series, 21 (60%) were found to have complete cessation of menstruation. Eleven (31.43%) resumed menstruating but at acceptable levels. Three patients (8.57%) had unsatisfactory results, one who later had a repeat ablation and two who had hysterectomies. Thus, 32 of 35 patients were successfully treated without further intervention after laser ablation. Nd:YAG endometrial ablation is efficacious and cost-effective for recurrent menometrorrhagia in selected patients. The additional benefit of this procedure is the avoidance of hysterectomies and postsurgical complications as well as the psychological consequences of a hysterectomy.