A new meta-study has found that surgery is more effective than oral or intrauterine medication in reducing heavy periods. But as far as satisfaction and improved quality of life are concerned, a hormone-releasing intrauterine device (IUD) was as effective as surgery, say the researchers. Heavy menstrual bleeding affects around 20 percent of women of reproductive age and is the most common cause of anemia in premenopausal women. The treatments available include oral drugs and a hormone-releasing IUD to decrease blood loss, while surgical options range from procedures that remove the lining of the uterus to hysterectomy (removing the uterus entirely).
Hysterectomy has traditionally been considered the definitive treatment for heavy menstrual bleeding, since removal of the uterus brings an end to menstruation. Of the approximately 600,000 hysterectomies performed in the United States each year, about 20 percent to 30 percent are done to treat excessive uterine bleeding. However, hysterectomy isn't an option for women who plan to have children, and its greater success in resolving heavy menstrual bleeding is also associated with greater risk.
Comparing surgery and oral medications, the researchers found surgery to be more effective in controlling bleeding and other symptoms and improving generally the women's quality of life. Of the trials that compared hormone-releasing IUDs to surgery, surgery resulted in better control of bleeding than the IUD. However, improvements in quality of life were similar in the two groups of women, and those who received the IUD were as likely to be satisfied with their outcome as women who underwent conservative surgery.
Health-related quality of life and satisfaction rates were also equivalent in the comparison between hysterectomy and the IUD. Around 58 percent of women randomized to receive the IUD were able to avoid hysterectomy. Moreover, the costs associated with the IUD were about 40 percent lower than for hysterectomy.
"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," said the review co-author Jane Marjoribanks, at the University of Auckland, in New Zealand.
Source: Health Behavior News Service
