Heavy Menstrual Bleeding

“Women should have access to all the available treatment modalities in order to satisfy their preferences and optimize clinical outcomes.”

Heavy menstrual bleeding is the most common presenting problem in modern gynecological practice and an appreciation of the epidemiology is beneficial to gynecologists, their patients and service planners. Optimal management of heavy menstrual bleeding also requires an understanding of the etiology and how best to diagnose the underlying pathologies. Women should have access to all the available treatment modalities in order to satisfy their preferences and optimize clinical outcomes. Those delivering health services for menstrual disorders should ensure that pathways are in place to provide comprehensive and contemporary treatments. Thus, medical therapies, surgical and radiological treatment options should be readily available. Recent evidence supports medical treatments such as first-line local intrauterine progestins and the selective progesterone modulator, ulipristal acetate, prior to surgical treatment of fibroids. Endoscopic surgical techniques have developed such that women should have access to hysteroscopic resection or morcellation of intracavity focal anomalies such as polyps or fibroids. Total and subtotal laparoscopic hysterectomy, facilitated by improved instrumentation, is reducing the need for abdominal approaches potentially lowering rates of surgical morbidity. Uterine artery embolization avoids the invasiveness of surgery and is now an established, effective treatment for fibroids but other exciting radiological techniques continue to be developed.

In this themed section of the journal, we have aimed to provide the reader with an up-to-date, inclusive review of the management of heavy menstrual bleeding incorporating chapters on epidemiology, etiology, diagnosis and treatment whether medical, surgical or radiological. We hope you find it informative, relevant and enjoyable.