Reducing Hysterectomy Rates: Transcervical Resection of the endometrium with Mirena- Role in abnormal uterine bleeding

Transcervical resection of the endometrium is a minimally invasive surgical procedure used to treat select cases of abnormal uterine bleeding (AUB). It involves excision of the superficial layers of the endometrium through the cervix, leaving the basal layer intact. The use of transcervical resection of the endometrium (TCRE) in conjunction with the insertion of Mirena, a trademarked hormonal intrauterine device (IUD) employed for contraception and the management of excessive menstrual bleeding, facilitates the procurement of tissue for histopathological analysis and is economically viable compared to hysterectomy. This study evaluated the effectiveness of TCRE with Mirena insertion for treating AUB. The objective of this study was to measure patient outcomes by examining amenorrhoea rates, complications, long-term effectiveness and associated costs. These costs were divided into direct costs, covering the expenses related to the procedure and hospitalisation and indirect costs, which included the number of workdays lost, the time taken to resume normal activities and morbidity. An ambispective (having both retrospective from 2013 to 2024 [August] and prospective components [from August 2024 to December 2024]) study was conducted on 50 women with AUB with failed medical management (6 months of medical treatment) who underwent TCRE with Mirena insertion at Sir Ganga Ram Hospital, Delhi, from 2013 to 2024. Patients were followed up for 3 months to 10 years. Data analysed included age, pre-operative symptoms, body mass index, procedure details, complications, histopathology results and menstrual outcomes. Amongst the 50 cases, the mean age was 40.42 years, with 32% of patients achieving amenorrhoea post-procedure. The majority (58%) of the patients experienced cyclical spotting, while 6% reported reduced menstrual flow. Of the 43 patients who received Mirena, 34% achieved amenorrhoea and 59% had cyclical spotting. The patient satisfaction rate was 94.12%. The unsatisfactory group underwent a hysterectomy. TCRE with Mirena insertion is an effective treatment for select cases of AUB, offering long-term symptom relief, low complication rate, histopathological diagnosis and cost-effectiveness in expert hands. Mirena insertion adds to the effectiveness of the long-term outcome. Further research with larger cohorts is required to optimise the results and reduce the need for hysterectomy.