Authors' objectives:

This report aims to synthesize the research evidence available on the diagnosis, management and treatment of menorrhagia.

Authors' recommendations: Menorrhagia - excessive regular menstrual blood loss - accounts for a significant proportion of gynaecological referrals and over half of all hysterectomies. A large proportion of women who complain of heavy periods and who receive treatment have menstrual blood loss within the normal range. Diagnostic dilatation and curettage (D&C) should not be performed on women aged under 40 and its use in older women could be replaced by cheaper and safer methods of endometrial sampling. One of the most commonly prescribed drugs in primary care, norethisterone, is possibly the least effective. Evidence suggests that tranexamic acid and mefenamic acid are among the most effective and acceptable of first line treatments. The hormone releasing intra-uterine device appears to be highly effective but is not yet licensed for use in menorrhagia. Endometrial resection and laser ablation are cheaper than hysterectomy and generally effective in the short term but a significant proportion of women require further surgery on one or more occasions. Surgeons must have the necessary training and skills before using less invasive surgical techniques such as endometrial resection and laser ablation. Women report high levels of satisfaction with hysterectomy which is totally effective; however, it is more expensive and involves a longer recovery period. Since no management option is superior in all respects, women should be assisted to make informed choices about how to be treated. Research is needed to compare the relative effectiveness and cost-effectiveness of the most promising forms of interventions in terms of blood loss, quality of life and patient acceptability.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 1995

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination