Evidencebased medical treatment and endometrial ablative techniques responsible for falling trends in hysterectomies
The article by Reid and Mukri showing falling trends in
hysterectomies in the United Kingdom over the years makes an interesting
reading but is hardly surprising. The trend is not limited to the UK but
is a worldwide phenomenon in developed as well as in developing nations.
The lower rate over the years has been due to varied reasons. The
publication of Royal College of Obstetricians and Gynaecologists Evidence
Based Guidelines recommending the use of effective haemostatic agents like
tranexamic acid , LNG-IUS (mirena), use of progestogens in right dosage in
right phase of the cycle and avoidance of medications like ethamsylate
which lacked evidence of efficacy have all played a major role in
successful treatment of menorrhagia avoiding hysterectomy. A drug named
centchroman developed by India as a weekly oral contraceptive pill has
also been shown to reduce blood loss during menstruation. The use of
minimal invasive surgeries like endometrial resection, laser therapy or
balloon therapy have also played a significant role in reducing number of
hysterectomies. The role played by media and better awareness amongst
women has played a part too as many women now demand and opt for
alternative treatments before finally agreeing for hysterectomy. However,
hysterectomy continues to be a lasting solution for intractable
menorrhagia and dysmenorrhoea not responding to medical and minimal
invasive treatments especially in presence of fibroids and adenomyosis.
Rapid Response:
Evidencebased medical treatment and endometrial ablative techniques responsible for falling trends in hysterectomies
The article by Reid and Mukri showing falling trends in
hysterectomies in the United Kingdom over the years makes an interesting
reading but is hardly surprising. The trend is not limited to the UK but
is a worldwide phenomenon in developed as well as in developing nations.
The lower rate over the years has been due to varied reasons. The
publication of Royal College of Obstetricians and Gynaecologists Evidence
Based Guidelines recommending the use of effective haemostatic agents like
tranexamic acid , LNG-IUS (mirena), use of progestogens in right dosage in
right phase of the cycle and avoidance of medications like ethamsylate
which lacked evidence of efficacy have all played a major role in
successful treatment of menorrhagia avoiding hysterectomy. A drug named
centchroman developed by India as a weekly oral contraceptive pill has
also been shown to reduce blood loss during menstruation. The use of
minimal invasive surgeries like endometrial resection, laser therapy or
balloon therapy have also played a significant role in reducing number of
hysterectomies. The role played by media and better awareness amongst
women has played a part too as many women now demand and opt for
alternative treatments before finally agreeing for hysterectomy. However,
hysterectomy continues to be a lasting solution for intractable
menorrhagia and dysmenorrhoea not responding to medical and minimal
invasive treatments especially in presence of fibroids and adenomyosis.
Competing interests:
None declared
Competing interests: No competing interests