Hysterectomy for Menorrhagia: When Is It Indicated?
Hysterectomy is definitive treatment for menorrhagia (heavy menstrual bleeding) when conservative options fail or are inappropriate.
Indications
- Intractable bleeding: Persists despite NSAIDs, tranexamic acid, hormonal therapy (OCP, IUD), endometrial ablation.
- Structural uterine pathology: Large fibroids, adenomyosis, congenital anomalies causing bleeding.
- Completed childbearing: Patient desires permanent contraception and bleeding resolution.
- Severe anemia/transfusion dependence: From chronic blood loss.
- Patient preference: After counseling on alternatives, some choose hysterectomy for certainty.
Alternatives to Try First
- Levonorgestrel IUD (first-line medical).
- Endometrial ablation (if uterus <10 cm, no malignancy).
- Uterine artery embolization (fibroids).
- Myomectomy (fertility preservation).
Hysterectomy is major surgery; decision requires thorough discussion of risks, benefits, alternatives, and patient values.
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