title: Ambulatory management of heavy menstrual bleeding.
abstract: Heavy menstrual bleeding (HMB) has significant adverse effects on the quality of life of many women, placing an economic burden on both health services and society at large. Thus, it is essential that all women with HMB have easy access to the proper diagnostic and therapeutic work-up in an outpatient fashion, avoiding the more time-consuming inpatient management. This new outpatient approach for HMB is one of the latest development of gynecological practice and can offer both diagnostic and therapeutic procedures. This manuscript aims to show the current possibilities of the modern management of HMB, which can be safely and effectively accomplished in the outpatient setting: global and directed endometrial biopsy, levonorgestrel intrauterine system insertion as well as minimally invasive surgical procedures (encompassing a variety of operative hysteroscopic procedures and second-generation endometrial ablation) are described below.
authors.affiliation: Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.affiliation: Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Marialuigia
authors.initials: M
authors.lastname: Spinelli
authors.affiliation: Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Brunella
authors.initials: B
authors.lastname: Zizolfi
authors.affiliation: Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D055356:Endometrial Ablation Techniques / Q000706:statistics & numerical data*; D004717:Endometrium / Q000601:surgery; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D008595:Menorrhagia / Q000188:drug therapy* / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D016387:Women's Health
chemical_list: D000933:Antifibrinolytic Agents
keywords: ambulatory setting; endometrial biopsy; heavy menstrual bleeding; levonorgestrel intrauterine system; office operative hysteroscopy; second-generation endometrial ablation