Evaluation of surgical options in menorrhagia

Total abdominal and vaginal hysterectomy has been the standard treatment for intractable and unmanageable menorrhagia for many years. However, in the last few years, hysteroscopic treatment of menorrhagia through surgical resection and/or ablation of the endometrial cavity has gained success. Over 625,000 hysterectomies are performed each year in the USA alone. More than 30% are done for menorrhagia as a primary diagnosis. Three times more hysterectomies are performed using the abdominal route than the vaginal approach. Morbidity is higher using the abdominal route alone. Complications of abdominal and vaginal hysterectomies will be briefly discussed. Menorrhagia caused by submucous fibroids can be treated hysteroscopically. A review of methods, complications, advantages and long-term follow up will be presented. Laparoscopically-assisted vaginal hysterectomy (LAVH) is the latest surgical option offered for menorrhagia. The advent of a hysteroscopic approach to the treatment of menorrhagia and careful analysis of the advantages and disadvantages of LAVH will be discussed.