Is hysteroscopy useful for heavy menstrual bleeding?

Q: My 38 year old wife has been suffering from prolonged menstrual bleeding with blood clots since last 2-3 years. A medical specialist was consulted and he has detected a small marble sized fibroid in the uterus. The medicine prescribed by the doctor are Cymin 500 and Sylate 500. The result of medicine is found to have temporary effect and the disease continues. Should she go for surgical removal of uterus? Is the surgery minor in nature? Will there be any side effect after surgery? Is there any other way to get rid of the fibriod without removal of uterus?

A:The management of prolonged / heavy menstrual bleeding (menorrhagia) in the perimenopausal age group like this lady has been revolutionised with the advent of HYSTEROSCOPY, avoiding many unnecessary hysterectomies (removal of the uterus and cervix). Since the haemostatic medication such as Cymin / Sylate (Etamsylate) have not helped in this lady, the following strategies can be planned:1. Evaluation of the uterine cavity with a hysteroscope (a telescope insertedinside the uterus under short general anaesthesia) with sampling of theendometrium (inner most lining of the uterus) for histopathological evaluation: Diagnostic hysteroscopy2. Treatment options possible are given below:

Resection of the endometrium (lining of the uterus): Therapeutichysteroscopy

Dilatation and curettage

Insertion of a new medicated intrauterine contraceptive device calledMIRENA: Almost non-invasive and highly effective

Thermal ablation of the endometrium called THERMACHOICE: Highlyeffective in the absence of fibroidsShould removal of the fibroid be the only concern, then laparoscopic /hysteroscopic myomectomy (depending on the site, size and number of fibroids)can be planned in consultation with the couple.