Abstract
Heavy and irregular menstrual bleeding (menorrhagia/metrorrhagia; MM) is common and affects between 10 and 30% of women of reproductive age. MM is associated with numerous clinical symptoms and a significant reduction in quality of life. The most important etiological factors of MM include endometrial polyps, myomas, adenomyosis, hyperplasia/malignancy, hereditary or acquired coagulation disorders, ovulatory dysfunction, and iatrogenic causes. The only definitive and therefore most effective treatment of MM is hysterectomy. Alternatives are uterus-conserving ablative approaches, e.g. endometrial resection (RS) and endometrial ablation (EA). In the case of hysterectomy, laparoscopic supracervical hysterectomy (LASH) is the method of first choice, if there are no specific reasons to remove the cervix. Conservative, non-surgical therapies of MM are available, including levonorgestrel-releasing intrauterine devices, oral/parenteral progestogens, oral/parenteral combination contraceptives, tranexamic acid, non-steroidal antirheumatics, selective progesterone receptor modulators, and gonadotropin releasing hormone agonists/antagonists.
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