1887
Volume 2003, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Menorrhagia and dysfunctional uterine bleeding are com-mon indications for referral to a gynecologist. One in 20 women aged 30-49 will consult her general practitioner every year com-plaining of heavy uterine bleeding. Over 70,000 hysterecto-mies are performed annually in the UK with menorrhagia being the commonest indication. In up to 30% of these cases the uterus is anatomically normal. To these women, heavy uterine bleed-ing brings considerable stress and disruption to their social, domestic and professional lives. In the UK, the cost of primary care prescriptions for the treatment of menorrhagia was esti-mated in 1998 to be around £7 million. Gynecologists have looked at less radical but effective alternatives to hysterectomy for the treatment of heavy uterine bleeding. While the MISTLE-TOE* audit had demonstrated a pivotal role for less extreme yet successful interventions than hysterectomy for the treatment of bleeding problems, there were some setbacks. Special skills are needed to perform rollerball and diathermy loop resections of the endometrium. As well as the risk of serious intra-opera-tive complications the techniques are relatively time consum-ing to perform. In the MISTLETOE audit there were two direct deaths as a consequence of the procedure and 1.26% of patients required emergency surgery. This review looks at two new in-terventions available for clinical use, in the short term they have both proven to be successful and safe in the management of heavy uterine bleeding. Individually, they offer distinct advan-tages in the successful treatment of heavy uterine bleeding with-out the disadvantages of major surgery or medical treatment. They are both relatively easy to learn and do not require ad-vanced hysteroscopic skills. A major step forward is the suit-ability for outpatient setting.

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