Influence of Endometrial Ablation Procedures Using Two Different Ways of Radiofrequency Thermocoagulation for Treatment of Dysfunctional Uterine Bleeding on Female Reproductive Endocrine

doi:10.3877/cma.j.issn.1673-5250.2013.03.002

Objective

To investigate the influence of serum menopause hormonal changes by different strategies of radiofrequency thermocoagulation (RFT) procedures to remove the endometria for treatment of dysfunctional uterine bleeding(DUB).

Methods

From January 2006 to January 2010, a total of 162 patients who were diagnosed as DUB were included into this study. Their ages ranged from 33 to 53 years old, and the average age was (44.5±7.5) years old. They were divided into RFT-A group (n=95, ≥45 years old) and RFT-B group (n=67, <45 years old) according to their ages. RFT-A group received RFT to remove all endometria and their therapeutic purposes were amenorrhoea. Meanwhile, RFT-B group received RFT to remove parts of endometria and their therapeutic purposes were to decrease menstrual blood quantity. All the patients had the results of pictorial blood loss assessment chart (PBAC), endometrial currettage pathology before the operation. And another six kinds of serum endocrine markers were detected, including estradiol (E₂), progesterone (P), testosterone (T), pituitary prolactin (PRL), corpus luteum erythropoietin (LH), follicle-stimulating hormone (FSH) before and after RFT within 6-12 and 12-24 months. Meawhile, another 68 healthy women were recruited as control group. They were divided into two groups according to their ages, too, control group-A (n=32, ≥45 years old) and control group-B (n=36, <45 years old). The six kinds of serum endocrine markers as the same as RFT groups were detected. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Jinan Millitary General Hospital. Informed consent was obtained from each participant.

Results

①Total effective rates of amenorrhoea of RFT-A group within 6-12 months after RFT was 96.8%(92/95), and within 12-24 months was 100%. ②The PBAC scores and hemoglobin (Hb) levels had significant improvement compared with pre-operation, with the significant difference (P<0.05). During 6-12 months followed-up, six patients showed poor effects (PABC scores>100) and received second RFT. The total effective rates of menstruation improvement of RFT-B group within 6-12 months after RFT was 91.0% (61/67). Among RFT group, two patients showed amenorrhea, for patients showed poor effects(PABC scores>100). Statistically, PBAC scores and Hb in RFT-A and RFT-B during followed-up were obviously improved (P<0.05). ②Levels of serum E₂, P, T, PRL, LH, FSH between two RFT groups within 6-12 and 12-24 months after RFT had no statistical difference(P>0.05). Thirty-three(34.7%, 33/95) patients in RFT-A groupo and 5 (7.5%) cases in RFT-B group which levels of serum E₂, LH, FSH reached levels of menopause in 12-24 months after RFT, which was statistically different (P<0.05). The incidence of perspiration and hot flashes in RFT-A group were 23.2% (22/95) before RFT and 26.3% (25/95) after RFT, 4.5% (3/67) and 3.0% (2/67) in RFT-B group. There was no statistically significant difference before and after RFT within 12-24 months of intra-group comparisons of both RFT groups (χ²=0, 254, 0.001; P>0.05); And there had significant difference before and after RFT within 6-12 months between RFT-A group and RFT-B group (χ²=10.506, 15.398; P<0.05).

Conclusions

RFT is a safe, effective and minimally invasive method in the treatment for DUB without postoperative gynecological endocrine change.

Key words: dysfunctional uterine bleeding, radiofrequency treatment, estradiol, luteinizing hormone, follicle stimulating hormone

表1 两组患者治疗前、后月经量PBAC评分结果和血红蛋白水平比较(±s)

Table 1 Comparision of PBAC scores and levels of hemoglobin between RFT-A and RFT-B group before and after radiofrequency thermocoagulation (±s)

随访时间		n	PBAC评分	Hb(g/L)	t	P
RFT-A组		95
	治疗前		167.3±72.0	87.2± 3.1
	治疗后6～12个月		－	110.6±10.8^a	2.320	<0.05
	治疗后12～24个月		－	127.7±10.0^b	2.438	<0.05
RFT-B组		67
	治疗前		187.5±59.5	87.2± 3.6
	治疗后6～12个月		55.3±21.5^a	122.5±11.2^a	2.373	<0.05
	治疗后12～24个月		50.9±19.9^b	130.8±11.0^b	2.414	<0.05

表1 两组患者治疗前、后月经量PBAC评分结果和血红蛋白水平比较(±s)

Table 1 Comparision of PBAC scores and levels of hemoglobin between RFT-A and RFT-B group before and after radiofrequency thermocoagulation (±s)

随访时间		n	PBAC评分	Hb(g/L)	t	P
RFT-A组		95
	治疗前		167.3±72.0	87.2± 3.1
	治疗后6～12个月		－	110.6±10.8^a	2.320	<0.05
	治疗后12～24个月		－	127.7±10.0^b	2.438	<0.05
RFT-B组		67
	治疗前		187.5±59.5	87.2± 3.6
	治疗后6～12个月		55.3±21.5^a	122.5±11.2^a	2.373	<0.05
	治疗后12～24个月		50.9±19.9^b	130.8±11.0^b	2.414	<0.05

表2 两组患者治疗前、后血清E₂，P，T，PRL，LH及FSH水平比较(±s)

Table 2 Comparision of serum E₂，P，T，PRL，LH and FSH levels between RFT-A and RFT-B groups before and after treatment by radiofrequency thermocoagulation (±s)

组别		n	E₂(ng/L)	P(μg/L)	T(μg/L)	PRL(μIU/mL)	LH(IU/L)	FSH(IU/L)
RFT-A组		95
	治疗前		37.9±22.5	2.3±1.7	0.6±0.2	246.6±122.7	12.8±3.5	16.2± 4.8
	治疗后6～12个月		30.5±24.1	2.3±1.7	0.5±0.3	298.6± 94.4	16.4±4.3	17.6±14.5
	治疗后12～24个月		33.7±20.5	2.1±1.3	0.5±0.2	311.6± 89.1	18.6±4.0	21.3±13.9
对照组-A		32	32.3±14.0	1.9±0.9	0.7±0.3	312.3±132.1	10.6±3.5	15.9±10.8
RFT-B组		67
	治疗前		50.3±20.3	2.2±1.1	0.5±0.3	367.6±141.1	5.9±3.2	7.4±3.6
	治疗后6～12个月		52.7±23.4	1.9±1.2	0.4±0.3	335.6± 82.0	5.6±4.1	6.4±2.8
	治疗后12～24个月		67.1±27.4	4.3±2.1	0.6±0.2	379.3± 90.6	7.9±3.7	8.7±4.4
对照组-B		36	41.7±18.5	1.7±1.0	0.5±0.1	351.6±126.0	7.6±3.0	6.9±4.1

表2 两组患者治疗前、后血清E₂，P，T，PRL，LH及FSH水平比较(±s)

Table 2 Comparision of serum E₂，P，T，PRL，LH and FSH levels between RFT-A and RFT-B groups before and after treatment by radiofrequency thermocoagulation (±s)

组别		n	E₂(ng/L)	P(μg/L)	T(μg/L)	PRL(μIU/mL)	LH(IU/L)	FSH(IU/L)
RFT-A组		95
	治疗前		37.9±22.5	2.3±1.7	0.6±0.2	246.6±122.7	12.8±3.5	16.2± 4.8
	治疗后6～12个月		30.5±24.1	2.3±1.7	0.5±0.3	298.6± 94.4	16.4±4.3	17.6±14.5
	治疗后12～24个月		33.7±20.5	2.1±1.3	0.5±0.2	311.6± 89.1	18.6±4.0	21.3±13.9
对照组-A		32	32.3±14.0	1.9±0.9	0.7±0.3	312.3±132.1	10.6±3.5	15.9±10.8
RFT-B组		67
	治疗前		50.3±20.3	2.2±1.1	0.5±0.3	367.6±141.1	5.9±3.2	7.4±3.6
	治疗后6～12个月		52.7±23.4	1.9±1.2	0.4±0.3	335.6± 82.0	5.6±4.1	6.4±2.8
	治疗后12～24个月		67.1±27.4	4.3±2.1	0.6±0.2	379.3± 90.6	7.9±3.7	8.7±4.4
对照组-B		36	41.7±18.5	1.7±1.0	0.5±0.1	351.6±126.0	7.6±3.0	6.9±4.1

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