Ablation Device May Not Require Leuprolide Step


SANTA FE, N.M. — Although the manufacturer of the Hydro ThermAblator recommends the use of leuprolide acetate to thin the endometrium before performing ablation with the device, this step may be unnecessary, William E. Crowder Jr., M.D., said at the annual meeting of the American Association of Gynecologic Laparoscopists.

In a nonrandomized study, 89 women with menorrhagia were assigned to one of three groups before undergoing treatment with the Hydro ThermAblator (HTA): endometrial thinning with leuprolide (3.75 mg in a single dose), oral contraceptives, or cycle timing. In the cycle timing group, women underwent HTA treatment in the early proliferative phase of the menstrual cycle. On follow-up, there were no differences in menstrual bleeding or patient satisfaction, said Dr. Crowder, a consultant to Boston Scientific, which manufactures the HTA system.

Despite his findings, Dr. Crowder said he is not recommending abandoning endometrial thinning agents. He said he would have to see the results of a randomized trial, currently in process, before he could make that recommendation.

In the current study, women in the three treatment groups rated their posttreatment bleeding on a scale of 1‐4 in which 1 is amenorrhea, 2 is hypomenorrhea, 3 is eumenorrhea, and 4 is menorrhagia. The three treatment groups averaged about 1.5 with no significant differences among them.

In terms of patient satisfaction, on a scale of 1‐3 in which 1 is a good outcome, 2 is fair, and 3 is poor, the average for all three groups was slightly over 1.0. There were no significant differences between groups, said Dr. Crowder, an ob.gyn. in Conroe, Texas.

About half the women in each group underwent ultrasound examination to measure endometrial thickness. Women taking leuprolide had thickness of 7.9 mm, those on oral contraceptives had thickness of 9.1 mm, and those on cycle timing had thickness of 12.0 mm, confirming that leuprolide and oral contraceptives were effective in thinning the endometrium.

Next Article: