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Surgical Management

  1. Uterus Conserving Surgeries for Dub (Endometrial Ablatio /Resection)

The various surgeries are:

  1. Transcervical resection of endometrium (TCRE),in which the basal endometrium is removed using diathermy loop
  2. Roller ball endometrial ablation
  3. Laser (Nd: YAG) endometrial ablation
  4. MEA (microwave of 9.2 GHz used for endometrial ablation)
  5. Uterine thermal balloon in which hot saline/ dextrose is circulated within the balloon after it is placed inside the uterus
  6. Hydrothermal ablator in which heated saline in circulated within uterine cavity

In a D/C, only superficial endometrium is removed which grows back, but in above minimally invasive surgeries the basal endometrium IS destroyed so that it does not regenerate back.


  • Patient's family should be complete
  • Histopathology: there should be no evidence of malignancy


  • Day care procedure
  • Major surgery such as hysterotomy is avoided


  • 40% patients will become amenorrheic.
  • 40% will have hypomenorrhea.
  • Only 20% will require hysterectomy.
  1. Simple Hystectomy (Abdominal / Vaginal - NDVH/ Laparoscopic)

Metropathia Hemorrhagica (Schroeder's Disease/Cystic Glandular Hyperplasia)

  1. This is usually seen in perimenopausal women due to infrequent/Irregular ovulation.
  2. The classical presenting feature is amenorrhea followed by menorrhagia.
  3. As there is no ovulation, there is unopposed estrogenic action on the endometrium leading to thickening of endometrium and a period of amenorrhea.
  4. After a variable period of time (6-8 weeks), the endometrial shedding happens (either due to decrease in estrogen or when the endometrium outgrows it blood supply), resulting in heavy bleeding.
  5. There is myohyperplasia, and there can be symmetric enlargement of uterus to about 8-10 weeks size and the endometrium looks thick, congested, and polypoidal.
  6. Histopathology: cystic glandular hyperplasia, Swiss cheese pattern (small and large empty glands with columnar epithelium), and absence of secretory changes.
  7. Swiss cheese pattern is also seen on ultrasonography in adenomyosis.

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