Menorrhagia treatment: surgery may eventually be needed
Many women taking hormone treatment or using the intrauterine device Mirena for menorrhagia, rather than undergoing hysterectomy, will eventually need surgery for their condition, two recent trials suggest.
A US trial randomly assigned 63 women with menorrhagia to undergo hysterectomy
or medical treatment with oestrogen and/or progesterone and/or a prostaglandin
synthetase inhibitor. The women had suffered abnormal bleeding for a
median of four years and had been dissatisfied with medroxyprogesterone
treatment.
At six months the surgical group had greater improvement in health-related
quality of life compared with those on medication. They showed improvements
in mental health scores as well as symptoms and overall health. By the
end of the two-year study, 53 per cent of women in the medicine group
had requested and received a hysterectomy. The women who continued medical
treatment also reported some improvements. By the end of the study, most
differences between the groups were no longer statistically significant
(JAMA 2004;291:1447).
The other trial, a five-year study in Finland, randomly assigned 236
women, newly referred to hospital with menorrhagia, to either hysterectomy
or treatment with
the intrauterine progestogen-only system (Mirena). After five years of
follow up the two groups did not differ substantially in terms of health-related
quality of life.
Although 42 per cent of women in the Mirena group eventually underwent
hysterectomy, the authors say that costs remained substantially lower
than in the surgery group (ibid p1456). |
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Pharmaceutical Journal
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