If bleeding is not controlled by medical management young female what is treatment of choice?
Dysfunctional uterine bleeding in most scenarios responds to medical management which includes use of Tranaxaemic acid ( most effective), NSAID’S, combined OC pills or even levonorgestrel releasing IUD.
In cases resistant to medical management surgical techniques like endometrial ablation ( first and second generation) can be done based on patient profile and relevant symptomatology. Hysterectomy though remains the most effective treatment but not routinely preferred as it’s associated with a high degree of morbidity, unless all other treatment options have failed.
First generation endometrial ablation techniques involve the use of a hysteroscope which allows for direct visualisation of endometrial cavity and include :- hysteroscopic laser ablation, trans cervical endometrial resection and rollerball endometrial ablation.
Second generation techniques don’t involve the use of a hysteroscope so an endometrial biopsy is needed before the procedure. These include microwave endometrial ablation, endometrial laser intrauterine thermal therapy, thermal balloon endometrial ablation etc. all these techniques offer 93-94 percent efficacy rates but recurrence of DUB can be seen.
Out of all the surgical methods being offered today hysterectomy is the only one which offers 100 percent efficacy rate