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CCBYNC Open access

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

Other information that should affect QUALYS

I read the abstract of this article in the GP edition of the BMJ. I
note that the paper is advocating Hysterectomy as a preferred strategy for
Heavy menstrual bleeding and that "Based on all available evidence on
effectiveness, cost, and utility values , hysterectomy is both more costly
and produces more QUALYS than the available alternatives ...likely to be
accepted by decision makers".

This is a discussion of removal of a woman's reproductive organs. This is
not a decision that any woman or surgeon could take lightly. It involves a
considerable period away from work, housework and sexual activity. It is
not uncommon for women to grieve the loss of their uterus. Sometimes
hysterectomy leads to low back pain presumably due to changes in hormones
and or muscle balance. Many women will have to choose a surgical menopause
at the same time due to age or disease such as endometriosis.

Then there are the women who get surgical complications and wound

Since the publication of the Million Women study many of these will
not choose HRT after their surgery.Some women will not be able to have HRT
due to other risk factors and may then suffer osteoporosis.

I imagine all these costs would be difficult to quantify but come and
sit in my surgery and meet these women and quantify their suffering.

As an undergraduate I studied the histology specimens of women who
had a hysterectomy for menorrhaghia, and most were "no pathology". The
condition is poorly understood and the research inadequate however the
Mirena/IUS or endometrial ablation allow women to either postpone
hysterectomy and therefore begin the process of accepting the loss or in
some cases avoid Hysterectomy by the onset of natural menopause leading to
cessation of menstruation.

The graph accompanying the article was not self explanatory and did
not assist in understanding which women could benefit from a less invasive
procedure such as Endometrial ablation or IUS fitting.

Competing interests: No competing interests

18 May 2011
Helen M Murrell
General Practitioner
Sunnisde surgery, NE16 5LP