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Management of Heavy Menstrual Bleeding: Is Hysterectomy the Radical Mastectomy of Gynecology?


Clinical Obstetrics and Gynecology: June 2007 - Volume 50 - Issue 2 - p 324-353
doi: 10.1097/GRF.0b013e31804a82e2
Current Controversies in Gynecology

Both hysterectomy for heavy menstrual bleeding and radical mastectomy for breast cancer are steeped in the history of surgery and have recently been challenged as being too radical for the disorder at hand. Radical mastectomy has largely been replaced with local removal of the tumor with subsequent radiation and/or chemotherapy. Alternatives to hysterectomy include a number of medical interventions, most notably intrauterine progestin-releasing systems, and endometrial ablation, a procedure that has a relatively high success rate and one that is now feasible for many women in an office or procedure room setting. However, although radical mastectomy rates have dropped precipitously, hysterectomy rates, at least in the United States remain relatively stable. Determining the proportion of hysterectomies that are done for heavy menstrual bleeding is difficult, largely because of coding issues, so it is difficult to measure the impact of new medical and minimally invasive surgical procedures. Nevertheless, it seems clear that many women are not exposed to the plethora of options to hysterectomy, a fact that may reflect a number of issues that may include training, skill, and financial incentives or disincentives. Clearly, options to hysterectomy are not a panacea, but if women are empowered to select from all of the options available, the rate of hysterectomy for bleeding should decrease while maintaining, or even enhancing the patient's satisfaction with care.

Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA; Kaiser Foundation Hospitals, Los Angeles Medical Center, Los Angeles, California

Correspondence: Malcolm G. Munro, MD, FRCS(c), FACOG, Kaiser Permanente Los Angeles Medical Center, Department of Obstetrics and Gynecology, 4900 Sunset Boulevard, Station 3-B, Los Angeles, CA 90027. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.