School of Medicine


MDSG topics

Excessive menstrual bleeding


                                                                                                                                        Key
                                                                                                                                        [R] = Review

                                                                                                                                        [P] = Protocol

Idiopathic excessive 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
    [R] Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen
    [R] Levonorgestrel-releasing intrauterine system for atypical endometrial hyperplasia
    [R] Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding 
  • 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] Endometrial resection and ablation techniques for heavy menstrual bleeding
    [R] Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding
    [R] Pre-operative endometrial thinning agents before endometrial destruction 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
    [R] Danazol for uterine fibroids 
  • Gestrinone
  • Gonadotrophin releasing hormones
    [P] Add-back therapy with GnRH analogues for uterine fibroids
    [R] Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids
  • Nonsteroidal anti-inflammatory drugs
  • Progestogens
    [R] Progestogen only versus combined oral contraceptive pills for fibroid related heavy menstrual bleeding
  • Other hormones
    [R] Mifepristone for uterine fibroids
    [R] Selective estrogen receptor modulators (SERMs) for uterine leiomyomas 
  • Herbal preparations
    [R] Acupuncture for uterine fibroids
    [R] Herbal preparations for uterine fibroids

Surgery

  • Dilatation and curettage
  • Endoscopic techniques
  • Hysterectomy
  • Myomectomy
    [R] Interventions to reduce haemorrhage during myomectomy for fibroids
    [R] Minimally invasive surgical techniques versus open myomectomy for uterine fibroids 
  • Uterine artery embolization
    [R] Laparoscopy versus embolization for for uterine artery occlusion for uterine fibroids
    [R] Uterine artery embolization for symptomatic uterine fibroids

Adenomyosis

Medical therapies

  • [P] Hormonal treatment for uterine adenomyosis  
Top