Managing menorrhagia: hysterectomy

Menorrhagia is not only heavy periods but usually also consists of pain, bouts of depression and menstrual headaches, as well as the exhaustion and loss of libido that come with the combination of these symptoms. If medical therapy fails, the options are use of a Mirena coil or various types of endometrial ablation. A hysterectomy with or without bilateral oophorectomy should not be seen as a last option because it will remove any cyclical symptoms - not just the heavy periods. However, it is important that these women receive efficient HRT; a low dose of oestrogen is not usually sufficient. By far the best treatment involves the replacement of the lost ovarian androgens in the form of an implant of oestradiol and testosterone, repeated every 6 months.