Excessive menstrual bleeding

Idiopathic exccessive menstrual bleeding 

Investigation

• Endometrial sampling techniques/dilation and curettage
• Ultrasound of endometrium
• Hysteroscopy

Medical Therapies

• Antifibrinolytic agents
  [R] Antifibrinolytics for heavy menstrual bleeding
• Danazol
  [R] Danazol for heavy menstrual bleeding
• Hormone replacement therapy
• Levonorgestrel IUCD
• Nonsteroidal anti-inflammatory drugs
  [R] Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding
• Oral contraceptive pill
  [R] Oral contraceptive pills for heavy menstrual bleeding
• Other hormones
• Progestagens
  [R] Cyclical progestogens for heavy menstrual bleeding
  [R] Progesterone/progestogen releasing intrauterine systems for heavy menstrual bleeding

Surgery

• Dilatation and curettage
• Endometrial ablation or resection (all methods)
  [R] Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding
  [R] Endometrial destruction techniques for heavy menstrual bleeding
  [R] Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding
  [R] Surgery versus medical therapy for heavy menstrual bleeding
• Radiofrequency and microwave techniques
• Hysterectomy
  [R] Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding
  [R] Surgery versus medical therapy for heavy menstrual bleeding

Psychological

• Counselling

Treatment of fibroids

Medical Therapies

• Danazol
• Gestrinone
• Gonadotrophin releasing hormones
  [R] Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids
• Nonsteroidal anti-inflammatory drugs
• Progestogens
• Other hormones

Surgery

• Dilatation and curettage
• Endoscopic techniques
• Hysterectomy
• Myomectomy
  [P] Laparoscopic versus open myomectomy for uterine fibroids

Adenomyosis

[P] = Protocol