Re : Surgical management of heavy menstrual bleeding: part 2

Abstract

Key content Heavy menstrual bleeding affects one in five premenopausal women and can significantly impair quality of life. Management options for heavy menstrual bleeding are diverse and include a variety of medical, radiological and surgical treatments. Surgical treatment options are endometrial ablation, hysterectomy and myomectomy. Treatment choice for heavy menstrual bleeding should take into account underlying pathology, and the woman's preferences and fertility needs. Learning objectives To understand the efficacy, patient-centred outcomes, risk profile and cost-effectiveness of various surgical modalities for the treatment of heavy menstrual bleeding in premenopausal women. To evaluate differing surgical approaches and techniques for hysterectomy and myomectomy, and their advantages and limitations. To be able to undertake informed counselling about the different surgical treatment modalities for heavy menstrual bleeding. Ethical issues Is it justified to offer hysterectomy as a first choice surgical option that entails increased morbidity but has higher satisfaction rates and is more cost-effective? How can the continuing high rates of open abdominal hysterectomy be justified for a benign condition when the evidence clearly supports alternative routes? How are UK trainees to achieve the requisite skills to offer all surgical alternatives to women presenting with heavy menstrual bleeding within the present training system?