BMJ 1995;310:802-803 (25 March)

Letters

Appropriate comparison would be to compare the best of the old treatments with the best of the new

EDITOR,--S B Pinion and colleagues compared hysterectomy with endometrial ablation in the management of menorrhagia and not just dysfunctional uterine bleeding as suggested in the title of their paper.1 Of the group treated conservatively, 29% had positive findings, mainly fibroids; the percentage with positive findings rose to 34% in those treated by hysterectomy. While there is no evidence that endometrial ablation is appreciably less effective in women with small submucous fibroids,2 the title is nevertheless misleading.

We have two, more serious concerns. Only 12% of the patients randomised to hysterectomy underwent vaginal hysterectomy, which is a low figure, considering the indications for surgery. Vaginal hysterectomy has a lower morbidity than abdominal hysterectomy; patients have a reduced need for postoperative analgesia and are discharged home earlier.3 The most appropriate comparison for a treatment designed primarily for dysfunctional uterine bleeding must be vaginal hysterectomy. The use of abdominal hysterectomy increases the chance . . . [Full text of this article]


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