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[Treatment of menorrhagia--a surgical or medical approach?].

OBJECTIVE
A comparison of surgical and medical approaches to the therapy of menorrhagia.


DESIGN
A review article.


SETTING
Obstetrics and Gynaecological Department of the Masaryk Hospital in Ustí nad Labem.


SUBJECT
A comparison is made of advantages and disadvantages of different types of therapy of menorrhagia after introduction of minimal-invasive techniques of endometrial ablation. Details are given of the comparison of standard and global techniques of endometrial ablation and hysterectomy. Results of several randomised studies, especially retreatment rate, patient's satisfaction and cost-effectiveness are compared.


CONCLUSION
Endometrial ablation is an accepted standard alternative to hysterectomy for therapy of menorrhagia; it is not intended to replace hysterectomy. Hysterectomy ought to be the second-line treatment after ablation failures or for noncandidates for ablation. Mini-invasive techniques may be used as the first-line surgical option instead of medical therapy. Standard methods of endometrial ablation give 8-9 in 10 women definite chance of avoiding hysterectomy. Global techniques must be assessed in randomised studies. The individualisation of therapy and detailed information given to women lead to higher satisfaction with their treatment outcome.