Future research in menorrhagia

Menorrhagia is a common clinical problem in routine gynaecological practice. Optimal methods for diagnostic work up and therapeutic interventions remain topics for ongoing debate. This can be explained in part by rapid advances in diagnostic and therapeutic technologies. However, the limited quality of available evidence due to inadequate study conception, design and conduct is responsible for much of this uncertainty. Future research should concentrate on a robust approach to the assessment of health technologies used in diagnosis and treatment, so that relevant studies capable of answering well-formulated research questions are designed. Outcomes of importance to patients, namely health related quality of life, should be used as primary outcome measures. Specific areas highlighted for research in this review include the role of particular diagnostic modalities, such as ultrasound and hysteroscopy, in terms of their ability to change patient outcome thorough primary research and decision-analytic modelling. The place of minimally invasive therapies and appropriate utilisation of the outpatient 'ambulatory' setting requires clarification through randomised controlled trials. Economic endpoints need to be assessed to facilitate a rational basis on which to allocate resources and upon which to base clinical decisions.