Human Reproduction Update, Vol.8, No.1 pp.68-78, 2002
© European Society of Human Reproduction and Embryology 2002; all rights reserved
The surgical management of menorrhagia
1 Department of Endogynaecology, University of New South Wales, Australia 2 Academic Department of Gynaecological Surgery, University of Teesside, UK 4 Present address: King Edward Memorial Hospital, University of Western Australia
To whom correspondence should be addressed at: Jason A. Abbott, Department of Endo-Gynaecology, Royal Hospital for Women, Barker Street, Randwick NSW 2032, Australia. e-mail: abbottj{at}sesahs.nsw.gov.au
Abstract
Surgical treatment of menorrhagia is likely to be both successful and satisfactory to the patient. Correct diagnosis of the cause of menorrhagia is essential, and management should be directed to the specific cause of the problem. The question of which treatment is best is a complex one and involves balancing patient wishes, expected outcomes, complications, cost-effectiveness and quality of life issues. For the subset of women in whom dysfunctional uterine bleeding is diagnosed, the literature suggests that there is a hierarchy of treatments that, in descending order for both efficacy and patient acceptability, are: (i) hysterectomy; (ii) endometrial ablation (either first- or second-generation); (iii) the levonorgestrel intrauterine system; and (iv) medical treatments. All four of these options should be discussed with the patient and the relative advantages and disadvantages considered before a treatment decision is made. For patients in whom a pathological cause is diagnosed, specific treatments should be aimed at removal of the lesion and observation of the effect on menstrual status. In addition to the treatment options above, specific treatments such as hysteroscopic, laparoscopic or open excision of the lesion need to be considered. For interventional radiological procedures such as uterine artery embolization, further study is recommended before it can be considered as a safe and effective treatment for menorrhagia.
Key words: endometrial ablation / hysterectomy / menorrhagia / surgery / uterine artery embolization
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