Therapy of Menorrhagia – Surgical or MedicamentousApproach?

Terapie menoragie – chirurgický nebomedikamentozní přístup?

Objective:
A comparison of surgical and medical approaches to the therapy of menorrhagia.Design: A review article.Setting: Obstetrics and Gynaecological Department of the Masaryk Hospital in Ústí nad Labem.Subject: A comparison is made of advantages and disadvantages of different types of therapy ofmenorrhagia after introduction of minimal-invasive techniques of endometrial ablation. Detailsare given of the comparison of standard and global techniques of endometrial ablation andhysterectomy. Results of several randomised studies, especially retreatment rate, patient’s satisfactionand cost-effectiveness are compared.Conclusion: Endometrial ablation is an accepted standard alternative to hysterectomy for therapyof menorrhagia; it is not intended to replace hysterectomy. Hysterectomy ought to be the secondlinetreatment after ablation failures or for noncandidates for ablation. Mini-invasive techniquesmay be used as the first-line surgical option instead of medical therapy. Standard methods ofendometrial ablation give 8–9 in 10 women definite chance of avoiding hysterectomy. Globaltechniques must be assessed in randomised studies. The individualisation of therapy and detailedinformation given to women lead to higher satisfaction with their treatment outcome.

Klíčová slova:
menorrhagia, hysterectomy, ablation of the endometrium