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Hysterectomy should be last option

GPs should regard hysterectomy as the 'last option' for women with heavy menstrual bleeding, new NICE guidelines recommend.

Researchers estimate that as many as 60 per cent of

women with the condition

are currently treated by hysterectomy.

But the guidance urges GPs to first discuss a range of options with patients before referring them for radical and irreversible surgery. It stresses the need for good communication between women and GPs, so that patients can make 'informed decisions about their care and treatment'.

In women for whom drug treatment is appropriate, hormonal and non-hormonal treatments should be offered in the following order:

• levonorgestrel-releasing

intrauterine system for more than 12 months

• tranexamic acid, NSAIDs or combined oral contraceptives

• norethisterone (15mg) daily from days five to 26 of the

menstrual cycle, or injected long-acting progesterones.

Professor Mary Ann Lumsden, consultant in gynaecology at the Glasgow Royal Infirmary and chair of the guideline development group, said: 'Hysterectomies should now be rare as it is fundamental that all women with heavy periods know there is a range of treatment options, many of which don't require surgery.

'This guideline clearly sets out what the treatment options are for women with heavy periods, so that women can have an informed discussion with their health professional about their condition.'

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