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2015 ; 2015
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Menorrhagia
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Duckitt K
BMJ Clin Evid
2015[Sep]; 2015
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INTRODUCTION: Menorrhagia (also known as heavy menstrual bleeding) limits normal
activities, affects quality of life, and causes anaemia in two-thirds of women
with objective menorrhagia (loss of 80 mL blood per cycle). Prostaglandin
disorders may be associated with idiopathic menorrhagia and with heavy bleeding
due to fibroids, adenomyosis, or use of intrauterine devices (IUDs). Fibroids
have been found in 10% of women with menorrhagia overall and in 40% of women with
severe menorrhagia; but half of women having a hysterectomy for menorrhagia are
found to have a normal uterus. METHODS AND OUTCOMES: We conducted a systematic
overview, aiming to answer the following clinical question: What are the effects
of surgical treatments for menorrhagia? We searched: Medline, Embase, The
Cochrane Library, and other important databases up to February 2014 (Clinical
Evidence reviews are updated periodically; please check our website for the most
up-to-date version of this review). RESULTS: At this update, searching of
electronic databases retrieved 205 studies. After deduplication and removal of
conference abstracts, 102 records were screened for inclusion in the overview.
Appraisal of titles and abstracts led to the exclusion of 56 studies and the
further review of 46 full publications. Of the 46 full articles evaluated, three
systematic reviews and five RCTs were added at this update. We performed a GRADE
evaluation for 30 PICO combinations. CONCLUSIONS: In this systematic overview, we
categorised the efficacy for three surgical interventions based on information
about the effectiveness and safety of dilatation and curettage, endometrial
destruction (resection or ablation), and hysterectomy.