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Systematic Review with Meta-Analysis
Hysterectomy, endometrial destruction and the levonorgestrel intrauterine system are all effective therapies for heavy menstrual bleeding; satisfaction rates are highest after hysterectomy
  1. Ian S Fraser
  1. University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Ian S Fraser
    Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Camperdown, NSW 2006, Australia; ian.fraser{at}

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Heavy menstrual bleeding (HMB) is one of the commonest and most controversial of gynaecological complaints presenting both at primary care and specialist levels. There is controversy over terminologies and definitions,1 classification of underlying causes2 and over symptom assessment in clinical practice.3 For clinical purposes, HMB is best defined as excessive menstrual blood loss leading to interference with the physical, emotional, social and material quality of life of a woman, and which can occur alone or in combination with other symptoms.3 There is a general lack of clinical and research awareness that HMB is actually a symptom complex, lack of awareness of what aspects are important for women, and of the impact on quality of life and modern lifestyle.4 5 These are often incompletely taken into account in the design of clinical management trials, as exemplified in many of the trials …

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