Hysteroscopic Resection Versus Endometrial Ablation for Heavy Menstrual Bleeding: Long-Term Patient Satisfaction

Abstract

Introduction: Hysteroscopic resection of submucous fibroids and endometrial ablation are both used for heavy menstrual bleeding (HMB). Comparative long-term satisfaction data influence treatment selection.
Methods: Systematic review of prospective and retrospective studies with minimum 3-year follow-up. Outcomes were menstrual improvement, reintervention rates, and satisfaction scores. Studies with mixed pathologies were included if stratified.
Results: Twelve studies (n=3,100) were analyzed. Ablation showed higher initial satisfaction (85% vs. 78% at 1 year), but by 5 years, satisfaction was equivalent (75% vs. 74%). Reoperation rates at 5 years were 15% after ablation versus 9% after resection for fibroids. Ablation failure was more common in large uteri.
Discussion: Ablation offers faster recovery and good early outcomes, but resection provides more durable results for structural causes. Patient age and desire for future contraception affect choice.
Conclusions: For HMB without large fibroids, ablation achieves high long-term satisfaction; for submucous fibroids, resection reduces reintervention risk. Shared decision-making should incorporate uterine size and pathology.