EFFECTIVENESS OF THERMAL BALLOON ENDOMETRIAL ABLATION IN THE MANAGEMENT OF ABNORMAL UTERINE BLEEDING UNRESPONSIVE TO MEDICAL THERAPY: A PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Abnormal uterine bleeding; Thermal balloon endometrial ablation; Endometrial thickness; PBAC score; Minimally invasive gynecology; Refractory AUB; Menorrhagia.
Abstract
Background: Abnormal uterine bleeding (AUB) is a prevalent gynecological condition that significantly impairs quality of life, particularly among perimenopausal women. While medical therapy is the first-line treatment, a substantial proportion of women fail to achieve adequate symptom control and require minimally invasive alternatives. Thermal balloon endometrial ablation (TBEA) has emerged as a safe and effective uterus-preserving option for such cases.
Objectives: To evaluate the clinical efficacy, hematological improvement, and safety profile of thermal balloon endometrial ablation in women with AUB refractory to medical management.
Methods: This prospective observational study included 30 women aged 35–50 years with AUB persisting despite at least six months of medical therapy. Baseline assessments included PBAC scoring, pelvic examination, Pap smear, endometrial biopsy, ultrasound evaluation, and hemoglobin estimation. All participants underwent TBEA under anesthesia. Follow-up was conducted at 10 days, 1 month, and 3 months, assessing menstrual outcomes, PBAC score, endometrial thickness, hemoglobin level, and postoperative complications.
Results: The mean pre-treatment PBAC score significantly reduced from 740.0 ± 108.8 to 142.8 ± 189.6 at three months, corresponding to an 80.7% reduction (p < 0.001). Endometrial thickness decreased from 9.24 ± 1.26 mm to 5.55 ± 0.47 mm, a 40% reduction (p < 0.001). Hemoglobin levels showed a significant improvement from 9.43 ± 1.13 g/dL to 9.87 ± 0.76 g/dL (p = 0.027). No major intraoperative or postoperative complications were observed, and patient satisfaction was high at follow-up.
Conclusion: Thermal balloon endometrial ablation is a highly effective and safe treatment modality for AUB refractory to medical therapy. It offers substantial reduction in menstrual blood loss, normalization of endometrial thickness, improvement in hemoglobin levels, and excellent patient satisfaction. TBEA represents a valuable minimally invasive alternative to hysterectomy, particularly in resource-limited settings.
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Dr Shruti Gaur
Assistant Professor Department of Obstetrics and Gynaecology Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India
Dr Ayushi Shukla
Junior Resident Department of Obstetrics and Gynaecology United Institute of Medical Sciences , Prayagraj, Uttar Pradesh, India
Dr Avinash Tiwari
Junior Resident Department of General Medicine Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India