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  Hysterectomy For Heavy Periods

Heavy menstrual bleeding is a common complaint amongst women of reproductive age. Rather than occurring as an isolated symptom, a careful history is likely to elicit other associated co-morbid problems such as pain, headaches and low mood. The effect of these may vary from being a minor nuisance to severely affecting a woman's quality of life such that she may only enjoy as few as seven good days a month.

Many women may opt for treatments that are non-surgical and appear to adequately control their primary complaint of heavy bleeding. A number of treatments such as the levonorgestrel releasing intrauterine system, and endometrial ablation are emerging as promising techniques for the treatment of menorrhagia and may form part of the management options. They offer advantages such as reduced hospitalisation, and a quick return to normal activities. Despite the exciting role many of the less invasive techniques may play, there remain a number of women who are treatment failures, and many long-term follow-up studies suggest that a considerable number of women require further procedures.

As a treatment of heavy bleeding, no method offers as high a patient satisfaction rate or total permanent cure as hysterectomy. There are a number of different routes and surgical techniques for performing hysterectomy, and the particular procedure often depends on the woman's wishes, the individual surgeon's expertise, and the presence of other symptoms or pathology. If combined with bilateral oophorectomy, there are additional benefits of alleviation of cyclical mood changes, headaches and pain. It is of vital importance that these women are carefully counselled both pre and post-operatively about hormone replacement therapy. Removal of the uterus obviates the requirement for adding a progestogen component to HRT. The absence of uterine bleeding and progestogenic side-effects facilitates the uptake of HRT and with dedicated follow-up high long-term continuation rates can be achieved in this group of women.


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