Surgical management of heavy menstrual bleeding: part 1

Abstract

Key content Heavy menstrual bleeding affects one in five premenopausal women and significantly impairs quality of life. Management options for heavy menstrual bleeding are diverse and include a variety of medical and surgical treatments. Surgical treatment options are endometrial ablation, hysterectomy and myomectomy. Treatment choice for heavy menstrual bleeding should take into account the underlying pathology, the woman's preferences and fertility needs. Learning objectives To review the first‐ and second‐generation endometrial ablation techniques and evaluate the role of outpatient ablation. To discuss efficacy, safety, acceptability and cost‐effectiveness of various ablation techniques for the treatment of heavy menstrual bleeding in premenopausal women. Ethical issues Is it justified to offer endometrial ablation as a first choice surgical option for the management of heavy menstrual bleeding? Would a move to second‐generation ablation techniques result in loss of operative hysteroscopic skills that may be required for treating intrauterine pathology? With the rising trend of women having more than one caesarean section is it safe to use blind global ablative techniques?