chapter  13
Current surgical treatment options: an evidence-based approach
ByErik Qvigstad, Olav Istre
Pages 5

Heavy menstrual bleeding (HMB) is the dominant complaint in women with abnormal uterine bleeding (AUB), even though long duration of bleeding and intermenstrual bleeding or spotting may be of concern in some women. These bleeding disturbances are classified as dysfunctional when no pathogenic mechanism can be demonstrated. First-line therapy is usually with drugs described by general practitioners. The efficacy of medical treatment is variable, and surgical treatment often follows failed or ineffective medical therapy. However, there has been concern that unnecessary surgery is being performed and that treatment of this condition is not an evidencebased approach. 1

Hysterectomy has been regarded as the definitive surgical treatment for HMB/AUB and has been a very commonly performed operation. 2 The uterus may be removed by open abdominal procedure, or laparoscopic or vaginal hysterectomy. There is evidence that the vaginal 3 or laparoscopic routes 4 are associated with shorter recovery time and fewer complications than the abdominal route. Since hysterectomy is a major surgical procedure with certain complications and adverse effects, and HMB is a benign condition, many women request less invasive alternatives. The less invasive surgical techniques, with the purpose of removing the entire thickness of the endometrium, were first introduced in 1981. 5 Since then, numerous equipments, techniques, and procedures have been developed.