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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