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Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis

BMJ 2011; 342 doi: (Published 26 April 2011) Cite this as: BMJ 2011;342:d2202

Consider cause specific treatment for Heavy menstrual bleeding

Heavy menstrual bleeding is the consequence of a number of causes.
Uterine fibroids, adenomyosis and haemophilias such as von-Willebrand's
are amongst the commonest. This is in contrast with , say, chickenpox
which is caused by a single strain of an infective agent.

And therin lies the problem of comparing treatments for heavy
menstrual bleeding. Contrasting randomly assigned treatments with the aim
of ranking them in order for efficacy, or economic value just does not
work for heavy menstrual bleeding in the way that we would be able to
compare and contrast the effects of two or more antibiotics in their
action against a particular infective organism.

Were we to consider and then to discover exactly why a particular
person had heavy menstrual bleeding, and what the optimum treatment for
that particular cause was, we would be in a far better situation than we
are currently in. More importantly, we would know what ineffective
treatments to avoid.

Competing interests: No competing interests

10 May 2011
Malcolm John Dickson
Consultant Obstetrician & Gynaecologist
Fatima Amna
Rochdale Infirmary, Lancashire, OL12 0NB