Progressively heavier menstrual bleeding
A 46 year old woman presented to her general practitioner with a one year history of progressively heavier menstrual bleeding. Her menstrual cycle remained regular (her usual 28 day cycle), but at times the bleeding would continue for longer, up to 10 days compared with her usual six days. She was now using 10 sanitary towels a day and was feeling very tired. Occasionally she was not able to go to work because the bleeding was so heavy. Her general practitioner referred her to hospital for investigation.
Surgical treatment-Hysteroscopic resection of submucous fibroids under general anaesthesia is the ideal. This procedure is the mainstay of treatment and gives 80% success in reducing menorrhagia. Hysteroscopic resection may even be done under local anaesthesia. Currently this is not well developed outside specialist centres, but it is a developing ambulatory technique that is likely to expand in the future. For other types of