Heavy menstrual bleeding (HMB) is a common problem which has a major impact on women’s physical, emotional, social and material quality of life. If initial treatment in primary care fails or is deemed unsuitable, surgical options such as endometrial ablation (EA) or hysterectomy can be offered.
While clinically and economically more effective than EA, a total hysterectomy involves a longer hospital stay, slower recovery and a higher risk of complications. The advantages of total hysterectomy could be maintained, whilst the risk of complications reduced, by undertaking a laparoscopic supracervical hysterectomy (LASH) where only the body of the uterus is removed.
HEALTH was a multi-centre trial, funded by the NIHR HTA programme, comparing the clinical and cost-effectiveness of LASH with second generation EA in women with HMB. A total of 660 women across 31 UK secondary and tertiary hospitals were recruited into the trial and followed-up to 15-months post-randomisation.
Conclusion: LASH was found to be superior to EA in terms of participant satisfaction and disease specific quality of life. EA was less costly in the short term, however, with its higher failure rate, LASH may be considered cost-effective by 10 years post procedure.
The trial was led by Professor Siladitya Bhattacharya based at the University of Aberdeen and Professor Kevin Cooper based at Aberdeen Royal Infirmary.
- Suzanne Breeman; firstname.lastname@example.org
The 15-month clinical results were published in The Lancet 2019, volume 394, issue 10207, pages 1425-1436 (https://doi.org/10.1016/S0140-6736(19)31790-8)
Full results from the 15-month follow-up period have been published in Health Technology Assessment 2019, volume 23, issue 53 (https://doi.org/10.3310/hta23530)
The HEALTH protocol was published in Trials 2018, volume 19, issue 63 (https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2374-9)