Laser photovaporization of endometrium for the treatment of menorrhagia.

As an alternative to hysterectomy in patients with excessive bleeding, the endometrium was destroyed by means of the neodymium-YAG laser. The photovaporization was done under direct vision through a hysteroscope. Twenty-two patients have been treated, all but one successfully, i.e., little or no menstrual flow. The human uterus having a thick myometrium was found to be ideal for this modality. To suppress endometrial regeneration further, each patient was placed on a regimen of danazol for 2 to 3 weeks prior to and after the procedure. Hysterograms after laser photovaporization showed variable degrees of uterine contraction, scarring, and adhesion formation. Biopsies of the endometrial surface up to 20 months following the procedure showed no evidence of inflammation other than foreign body giant cell reaction around carbon particles. Minimal endometrial regeneration occurred.