Once the pelvis was selleck chemicals assessed intra-abdominally, the laparoscopic ultrasound enabled mapping of the myoma. Under laparoscopic guidance, an RF probe was inserted percutaneously into the uterus and the myomas were targeted via ultrasound guidance and the probe was positioned 1 cm into the fibroid. Dual monitors were used to provide simultaneous laparoscopic and ultrasound imaging. Once the target temperature of 100��;C was achieved, it was maintained for the duration of the ablation. As in the Acessa trial, the patients were followed up at 3-month intervals for 1 year. Symptom severity scores reduced gradually and significantly (P < .05): baseline (63.3), 3 months (23.1), 6 months (15.4), and 12 months (9.6). Quality of life scores also improved (P < .05): baseline (37.3), 3 months (79.
9), 6 months (85.1), and 12 months (87.7).36 Conclusions Menorrhagia affects a large proportion of women and accounts for a substantial percentage of gynecologic referrals to secondary care. Even though multiple medical and surgical options exist to control HMB, they are all associated with side effects and implications, thereby limiting their use and therapeutic abilities. Guidelines issued by the Royal College of Obstetricians and Gynecologists acknowledge that menorrhagia is often inappropriately managed and there is a need for further research in order to develop efficient, patient-friendly, and cost-effective drugs. With the development of new medical and surgical options, which have proven to be effective and associated with a greater patient satisfaction rate, further alternatives to invasive surgeries will become available.
Main Points Heavy menstrual bleeding (HMB) is a benign yet debilitating social and health condition. It is clinically defined as blood loss �� 80 mL per menstrual cycle. In the United Kingdom, HMB accounts for > 20% of gynecologic referrals and cost the National Health Service ��50 million in 2010. HMB can be caused by fibroids, uterine polyps, or endometriosis. Other conditions, such as coagulation disorders and endocrine disorders, can also cause HMB. In some cases, the cause of bleeding in premenopausal women may be due to gynecologic malignancy. The ultimate goal of any form of treatment is to reduce menstrual flow in order to improve quality of life. Pharmaceutical therapy has always been considered the first-line treatment.
Conservative and uterinepreserving treatment options are obviously preferred. Medical therapies include the combined oral contraceptive pill, oral progesterone, nonsteroidal Batimastat anti-inflammatory drugs, tranexamic acid, and the levonorgestrel-releasing intrauterine system. Surgical management options include endometrial ablation, uterine artery embolization, uterine artery occlusion, and hysterectomy. Future treatment options include gonadotropin-releasing hormone antagonists, selective estrogen receptor modulators, and progesterone receptor antagonists, among others.