Menorrhagia is defined as a complaint of heavy cyclical menstrual bleeding over several consecutive cycles. It is a common problem and accounts for 35% of consultations in gynaecology outpatient departments. Hysterectomy, traditionally the definitive treatment for menorrhagia in approximately 60% of cases, is a major operation with potential morbidity and mortality.
Alternatives include medical treatment, which can be limited by the unfavourable side effects and lack of efficacy. The progestogen-releasing IUS is an effective and well-tolerated alternative and is being increasingly used; however, it is not suitable if the uterine cavity is distorted by fibroids.
Surgical options of management also include minimal invasive procedures such as first generation endometrial resection/ablation (laser ablation, rollerball ablation, TCRE) and second generation endometrial ablative techniques (Thermal balloon ablation, microwave ablation, hydrothermal ablation, bipolar radiofrequency ablation and endometrial cryotherapy) which are continuously evolving with improved safety and efficacy. Newer third generation techniques (Thermachoice III) also exist.
The aim of all of the second generation techniques is to limit uterine bleeding or produce amenorrhoea that is a type of therapeutic Asherman's syndrome.