A 30-year-old woman with heavy menstrual bleeding for 18 months has failed medical therapy with tranexamic acid and combined oral contraceptive pills. She has completed family planning. Endometrial biopsy shows simple hyperplasia without atomy. Hysteroscopy and directed biopsy confirm no focal lesion. Which is the most appropriate definitive surgical management to offer?
- A Second-generation endometrial ablation (thermal balloon) ✓
- B Uterine artery embolization
- C Total laparoscopic hysterectomy
- D Abdominal myomectomy
Correct answer: A. Second-generation endometrial ablation (thermal balloon)
Explanation
For heavy menstrual bleeding refractory to medical therapy with no structural cause, second-generation endometrial ablation is a minimally invasive definitive option when family is complete. Hysterectomy is more invasive and reserved for failed ablation. Myomectomy treats fibroids, which were excluded. Uterine artery embolization is for fibroids, not AUB-E. NICE guidelines endorse ablation as first-line surgical option before hysterectomy.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.