Options for Heavy Menstrual Bleeding

May 11, 2006 -- Treating heavy menstrual periods with a hormone-releasing intrauterine device (IUD) may be just as good as potentially riskier surgery for improving women's quality of life.

A new study shows surgery is still the most effective treatment option for women who experience heavy menstrual periods. But researchers found women treated with an IUD were just as likely to be satisfied with their treatment as women who underwent conservative surgery. Conservative surgery destroys only the lining of the uterus whereas a hysterectomy removes the entire uterus.

"Satisfaction with treatment is probably more meaningful than estimates of blood loss. While conservative surgery reduced blood loss more than the IUD, the two treatments appeared about equal in terms of patient satisfaction," says researcher Jane Marjoribanks, of the University of Auckland in New Zealand, in a news release.

Researchers say the results also confirm what many gynecologists have long suspected -- that treatment with birth control pills and other oral drugs are not all that effective in treating heavy menstrual bleeding.

Comparing Treatment Options

In the study, researchers reviewed eight studies involving 821 women that compared the effectiveness of surgery vs. IUD or oral drug treatment for heavy menstrual bleeding.

The results showed that a hysterectomy is the only treatment that is completely effective because it ends menstruation, but it also carries the highest risk. A hysterectomy also isn't an option for women who plan to have children.

More conservative surgical options for treating heavy menstrual bleeding include using an electric loop, laser, or hot water balloon to remove or destroy the lining of the uterus. These procedures have fewer risks than hysterectomy and can be done on an outpatient basis.

The study showed that conservative surgery was more than 10 times more effective than oral medications in controlling menstrual bleeding.

Two studies that compared conservative surgery vs. IUD also showed that conservative surgery was four times more effective in controlling bleeding after one year. But two smaller studies with longer follow-up periods showed no significant differences in effectiveness or favored treatment.

In addition, in comparing IUD vs. conservative surgery or hysterectomy one year after treatment, researchers found no significant difference in satisfaction rates or quality of life.

This study points out that there are many effective options open to women with heavy menstrual bleeding.

Researchers say that the risks associated with these options increase with the treatment's invasiveness and effectiveness; doctors should discuss benefits and risks of these treatment options thoroughly with their patients.

SOURCES: Marjoribanks, J. Cochrane Library, April 19, 2006; issue 2. News release, Health Behavior News Service.