Quality of Life, Anxiety and Depression in Women Treated with Hysteroscopic Endometrial Resection or Ablation for Heavy Menstrual Bleeding: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Salvatore Giovanni Vitale,
Gaetano Riemma,
Mislav Mikuš,
Jose Carugno,
Marco Torella,
Enrique Reyes-Muñoz,
Vito Cela,
Tirso Perez Medina,
Luigi Della Corte,
Luis Alonso Pacheco,
Sergio Haimovich,
Pasquale De Franciscis,
Stefano Angioni
Affiliations
Salvatore Giovanni Vitale
Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
Gaetano Riemma
Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
Mislav Mikuš
Department of Obstetrics and Gynecology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
Jose Carugno
Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, FL 33124, USA
Marco Torella
Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
Enrique Reyes-Muñoz
Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
Vito Cela
Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
Tirso Perez Medina
Department of Obstetrics and Gynecology, University Hospital Puerta de Hierro Majadahonda, Autonoma University of Madrid, 28001 Madrid, Spain
Luigi Della Corte
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
Luis Alonso Pacheco
Unidad de Endoscopia Ginecológica, Centro Gutenberg, 29010 Málaga, Spain
Sergio Haimovich
Department of Obstetrics and Gynecology, Laniado University Hospital, Netanya, Israel and Adelson School of Medicine, Ariel University, Ariel 98603, Israel
Pasquale De Franciscis
Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
Stefano Angioni
Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
Background and Objectives: Hysteroscopic endometrial resection (ER) or global endometrial ablation (GEA) are feasible methods to treat heavy menstrual bleeding (HMB). The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess patient’s quality of life (QoL) in women treated with ER/GEA compared to hysterectomy. Materials and Methods: Electronic searches in MEDLINE Scopus, ClinicalTrials.gov, EMBASE, PROSPERO and Cochrane CENTRAL were conducted from their inception to July 2022. Inclusion criteria were RCTs of premenopausal women with HMB randomized to conservative surgical treatment (ER/GEA) or hysterectomy. The primary outcome was the evaluation of QoL using the SF-36 score. Results: Twelve RCTs (2773 women) were included in the analysis. Women treated with hysteroscopic ER/GEA showed significantly lower scores for the SF-36 general health perception (mean difference (MD) −8.56 [95% CI −11.75 to −5.36]; I2 = 0%), social function (MD −12.90 [95% CI −23.90 to −1.68]; I2 = 91%), emotional role limitation (MD −4.64 [95% CI −8.43 to −0.85]; I2 = 0%) and vitality (MD −8.01 [95% CI −14.73 to −1.30]; I2 = 74%) domains relative to hysterectomy. Anxiety, depression scores and complication rates were similar between treatments. Relative to uterine balloon therapy, amenorrhea was more common with EA/GER (relative risk 1.51 [95% CI 1.03 to 1.20] I2 = 28%), but posttreatment satisfaction was similar. Conclusions: Women’s perception of QoL might be seen to be less improved after hysteroscopic ER/GEA rather than hysterectomy. However, such findings need to be confirmed by additional trials due to the high number of outdated studies and recent improvements in hysteroscopic instrumentation and techniques.
