[Methods and efficacy of medical and surgical treatment of non functional menorrhagia].
OBJECTIVE
To assess the efficacy of therapies in menorrhagia related to atypical endometrial hyperplasia, polyps, myoma, adenomyosis and arteriovenous malformation of the uterus.


METHODS
Medline and Cochrane contents were searched to June 2008.


RESULTS
Atypical endometrial hyperplasia is classically treated by hysterectomy, but may temporarily regress under hormone therapy (progestins, Gn-RH agonists) in women of childbearing age. Hysteroscopic resection is the standard treatment for endometrial polyps. Recurrence of bleeding is reduced by combining it with endometrial ablation. Myoma-related menorrhagia can be treated by Gn-RH agonists for 3 months or levonorgestrel in utero (LNG-IUS). Hysteroscopic resection is the standard treatment of submucous myomas. Interstitial myomas can be treated by myomectomy, myolysis, uterine artery embolisation or occlusion, or hysterectomy. Laparoscopic myomectomy and uterine artery embolisation are effective, well tolerated, and the best researched. LNG-IUS is effective and well tolerated to treat adenomyosis-related menorrhagia. The effect of other conservative treatments of the uterus (endometrial ablation, uterine artery embolisation or occlusion) is limited, especially in case of deep and extensive adenomyosis. Uterine artery embolisation is the standard treatment for arteriovenous malformation.


CONCLUSIONS
Numerous medical and technical innovations have been recently developed as conservative treatments for menorrhagia. However, hysterectomy remains the standard treatment of atypical endometrial hyperplasia and adenomyosis.
Brun
J-L
JL
Hôpital Pellegrin, service de gynécologie-obstétrique, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. jean-luc.brun@chu-bordeaux.fr
André
G
G
Descat
E
E
Creux
H
H
Vigier
J
J
Dallay
D
D
D001165:Arteriovenous Malformations / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D004621:Embolization, Therapeutic; D004714:Endometrial Hyperplasia / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D007889:Leiomyoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D011127:Polyps / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011247:Pregnancy; D011372:Progestins / Q000627:therapeutic use; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D014599:Uterus / Q000098:blood supply
D011372:Progestins; D007987:Gonadotropin-Releasing Hormone