Surgery versus medical therapy for heavy menstrual bleeding.

Abstract:

BACKGROUND:Heavy menstrual bleeding significantly impairs the quality of life of many otherwise healthy women. Perception of heavy menstrual bleeding is subjective and management usually depends upon what symptoms are acceptable to the individual. Surgical options include conservative surgery (uterine resection or ablation) and hysterectomy. Medical treatment options include oral medication and a hormone-releasing intrauterine device (LNG-IUS). OBJECTIVES:To compare the effectiveness, safety and acceptability of surgery versus medical therapy for heavy menstrual bleeding. SEARCH METHODS:We searched the following databases from inception to January 2016: Cochrane Gynaecology and Fertility Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and clinical trials registers (clinical trials.gov and ICTRP). We also searched the reference lists of retrieved articles. SELECTION CRITERIA:Randomised controlled trials (RCTs) comparing conservative surgery or hysterectomy versus medical therapy (oral or intrauterine) for heavy menstrual bleeding. DATA COLLECTION AND ANALYSIS:Two review authors independently selected the studies, assessed their risk of bias and extracted the data. Our primary outcomes were menstrual bleeding, satisfaction rate and adverse events. Where appropriate we pooled the data to calculate pooled risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs), using a fixed-effect model. We assessed heterogeneity with the I(2) statistic and evaluated the quality of the evidence using GRADE methods. MAIN RESULTS:We included 15 parallel-group RCTs (1289 women). Surgical interventions included hysterectomy and endometrial resection or ablation. Medical interventions included oral medication and the levonorgestrel-releasing intrauterine device (LNG-IUS). The overall quality of the evidence for different comparisons ranged from very low to moderate. The main limitations were lack of blinding, attrition and imprecision. Moreover, it was difficult to interpret long-term study findings as many women randomised to medical interventions subsequently underwent surgery. Surgery versus oral medicationSurgery (endometrial resection) was more effective in controlling bleeding at four months (RR 2.66, 95% CI 1.94 to 3.64, one RCT, 186 women, moderate quality evidence) and also at two years (RR 1.29, 95% CI 1.06 to 1.57, one RCT, 173 women, low quality evidence). There was no evidence of a difference between the groups at five years (RR 1.14, 95% CI 0.97 to 1.34, one RCT, 140 women, very low quality evidence).Satisfaction with treatment was higher in the surgical group at two years (RR 1.40, 95% CI 1.13 to 1.74, one RCT, 173 women, moderate quality evidence), but there was no evidence of a difference between the groups at five years (RR 1.13, 95% CI 0.94 to 1.37, one RCT, 114 women, very low quality evidence). There were fewer adverse events in the surgical group at four months (RR 0.26, 95 CI 0.15 to 0.46, one RCT, 186 women). These findings require cautious interpretation, as 59% of women randomised to the oral medication group had had surgery within two years and 77% within five years. Surgery versus LNG-IUSWhen hysterectomy was compared with LNG-IUS, the hysterectomy group were more likely to have objective control of bleeding at one year (RR 1.11, 95% CI 1.05 to 1.19, one RCT, 223 women, moderate quality evidence). There was no evidence of a difference in quality of life between the groups at five or 10 years, but by 10 years 46% of women originally assigned to LNG-IUS had undergone hysterectomy. Adverse effects associated with hysterectomy included surgical complications such as bladder or bowel perforation and vesicovaginal fistula. Adverse effects associated with LNG-IUS were ongoing bleeding and hormonal symptoms.When conservative surgery was compared with LNG-IUS, at one year the surgical group were more likely to have subjective control of bleeding (RR 1.19, 95% CI 1.07 to 1.32, five RCTs, 281 women, low quality evidence, I(2) = 15%). Satisfaction rates were higher in the surgical group at one year (RR 1.16, 95% CI 1.04, to 1.28, six RCTs, 442 women, I(2) = 27%), but this finding was sensitive to the choice of statistical model and use of a random-effects model showed no conclusive evidence of a difference between the groups. There was no evidence of a difference between the groups in satisfaction rates at two years (RR 0.93, 95% CI 0.81 to 1.08, two RCTs, 117 women, I(2) = 1%).At one year there were fewer adverse events (such as bleeding and spotting) in the surgical group (RR 0.36, 95% CI 0.15 to 0.82, three RCTs, moderate quality evidence). It was unclear what proportion of women assigned to LNG-IUS underwent surgery over long-term follow-up, as there were few data beyond one year. AUTHORS' CONCLUSIONS:Surgery, especially hysterectomy, reduces menstrual bleeding more than medical treatment at one year. There is no conclusive evidence of a difference in satisfaction rates between surgery and LNG-IUS, though adverse effects such as bleeding and spotting are more likely to occur with LNG-IUS. Oral medication suits a minority of women in the long term, and the LNG-IUS device provides a better alternative to surgery in most cases. Although hysterectomy is a definitive treatment for heavy menstrual bleeding, it can cause serious complications for a minority of women. Most women may be well advised to try a less radical treatment as first-line therapy. Both LNG-IUS and conservative surgery appear to be safe, acceptable and effective.

authors

Marjoribanks J,Lethaby A,Farquhar C

doi

10.1002/14651858.CD003855.pub3

subject

Has Abstract

pub_date

2016-01-29 00:00:00

pages

CD003855

issue

1

issn

1469-493X

pub_type

杂志文章,meta分析,评审
  • Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies.

    abstract:BACKGROUND:Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD012643.pub3

    authors: Aldin A,Umlauff L,Estcourt LJ,Collins G,Moons KG,Engert A,Kobe C,von Tresckow B,Haque M,Foroutan F,Kreuzberger N,Trivella M,Skoetz N

    更新日期:2020-01-13 00:00:00

  • Local cooling for relieving pain from perineal trauma sustained during childbirth.

    abstract:BACKGROUND:Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. This Cochrane Review is an update of a review last updated in 2012. OBJECTIVES:To evaluate the effecti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD006304.pub4

    authors: East CE,Dorward ED,Whale RE,Liu J

    更新日期:2020-10-09 00:00:00

  • Oral calorie supplements for cystic fibrosis.

    abstract:BACKGROUND:Poor nutrition occurs frequently in people with cystic fibrosis (CF) and is associated with other adverse outcomes. Oral calorie supplements are used to increase total daily calorie intake and improve weight gain. However, they are expensive and there are concerns they may reduce the amount of food eaten and...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000406.pub2

    authors: Smyth R,Walters S

    更新日期:2007-01-24 00:00:00

  • Adjuvant radiotherapy and chemoradiation after surgery for cervical cancer.

    abstract:BACKGROUND:There is an ongoing debate about the indications for, and value of, adjuvant pelvic radiotherapy after radical surgery in women with early cervical cancer. Certain combinations of pathologic risk factors are thought to represent sufficient risk for recurrence, that they justify the use of post-operative pelv...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007583.pub2

    authors: Rogers L,Siu SS,Luesley D,Bryant A,Dickinson HO

    更新日期:2009-10-07 00:00:00

  • Non-pharmaceutical measures for prevention of post-thrombotic syndrome.

    abstract:BACKGROUND:Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic pain, swelling and skin changes in the affected limb. One in every three patients with DVT will develop post-thrombotic complications within five years. OBJECTIVES:To determine the relative effe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004174.pub2

    authors: Kolbach DN,Sandbrink MW,Hamulyak K,Neumann HA,Prins MH

    更新日期:2004-01-01 00:00:00

  • Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes.

    abstract:BACKGROUND:Immediate delivery of the preterm fetus with suspected compromise may decrease the risk of damage due to intrauterine hypoxia. However, it may also increase the risks of prematurity. OBJECTIVES:To assess the effects of immediate versus deferred delivery of preterm babies with suspected fetal compromise on n...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008968.pub3

    authors: Stock SJ,Bricker L,Norman JE,West HM

    更新日期:2016-07-12 00:00:00

  • Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults.

    abstract:BACKGROUND:Acute lateral ankle ligament injuries (ankle sprains) are common problems in acute medical care. The treatment variation observed for the acutely injured lateral ankle ligament complex suggests a lack of evidence-based management strategies for this problem. OBJECTIVES:The objective of this review was to as...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003762

    authors: Kerkhoffs GM,Rowe BH,Assendelft WJ,Kelly K,Struijs PA,van Dijk CN

    更新日期:2002-01-01 00:00:00

  • Continuation and maintenance treatments for depression in older people.

    abstract:BACKGROUND:Depressive illness in older people causes significant suffering and health service utilisation. Relapse and recurrence rates are high. OBJECTIVES:To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people. SEARCH METHODS:Sea...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006727.pub2

    authors: Wilkinson P,Izmeth Z

    更新日期:2012-11-14 00:00:00

  • Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults.

    abstract:BACKGROUND:Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patient...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006276.pub2

    authors: Robb KA,Bennett MI,Johnson MI,Simpson KJ,Oxberry SG

    更新日期:2008-07-16 00:00:00

  • Pain management for sickle cell disease.

    abstract:BACKGROUND:Sickle cell disease is an inherited genetic disorder characterized by an abnormality of haemoglobin that predisposes to polymerization and consequent deformation ("sickling"). Sickle cell disease can cause episodes of acute severe pain. Chronic pain may also occur. Currently, pain is inadequately managed. O...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003350.pub2

    authors: Dunlop RJ,Bennett KC

    更新日期:2006-04-19 00:00:00

  • Medical day hospital care for the elderly versus alternative forms of care.

    abstract:BACKGROUND:The proportion of the world's population aged 60 or over is increasing. This review sets out to examine the effectiveness and resource implications of geriatric medical day hospital attendance for elderly people. This is an update of a Cochrane review first published in 1999. OBJECTIVES:To examine the effec...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001730.pub2

    authors: Forster A,Young J,Lambley R,Langhorne P

    更新日期:2008-10-08 00:00:00

  • Intra-uterine insemination for unexplained subfertility.

    abstract:BACKGROUND:Intra-uterine insemination (IUI) is a widely-used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD001838.pub6

    authors: Ayeleke RO,Asseler JD,Cohlen BJ,Veltman-Verhulst SM

    更新日期:2020-03-03 00:00:00

  • Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review.

    abstract:BACKGROUND:Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symp...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD013779

    authors: Pollock A,Campbell P,Cheyne J,Cowie J,Davis B,McCallum J,McGill K,Elders A,Hagen S,McClurg D,Torrens C,Maxwell M

    更新日期:2020-11-05 00:00:00

  • Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury.

    abstract:BACKGROUND:High intracranial pressure (ICP) is the most frequent cause of death and disability after severe traumatic brain injury (TBI). It is usually treated with general maneuvers (normothermia, sedation, etc.) and a set of first-line therapeutic measures (moderate hypocapnia, mannitol, etc.). When these measures fa...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD003983.pub3

    authors: Sahuquillo J,Dennis JA

    更新日期:2019-12-31 00:00:00

  • Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases.

    abstract:BACKGROUND:Animal and physiological research as well as observational studies suggest that antioxidant supplements may improve survival. OBJECTIVES:To assess the effect of antioxidant supplements on mortality in primary or secondary prevention randomised clinical trials. SEARCH STRATEGY:We searched The Cochrane Libra...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007176

    authors: Bjelakovic G,Nikolova D,Gluud LL,Simonetti RG,Gluud C

    更新日期:2008-04-16 00:00:00

  • Pharmacological interventions for non-alcohol related fatty liver disease (NAFLD): an attempted network meta-analysis.

    abstract:BACKGROUND:Non-alcohol related fatty liver disease (commonly called non-alcoholic fatty liver disease (NAFLD)) is liver steatosis in the absence of significant alcohol consumption, use of hepatotoxic medication, or other disorders affecting the liver such as hepatitis C virus infection, Wilson's disease, and starvation...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011640.pub2

    authors: Lombardi R,Onali S,Thorburn D,Davidson BR,Gurusamy KS,Tsochatzis E

    更新日期:2017-03-30 00:00:00

  • Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology.

    abstract:BACKGROUND:Advances in cell culture media have led to a shift in in vitro fertilization (IVF) practice from early cleavage embryo transfer to blastocyst stage transfer. The rationale for blastocyst culture is to improve both uterine and embryonic synchronicity and enable self selection of viable embryos thus resulting ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002118.pub4

    authors: Glujovsky D,Blake D,Farquhar C,Bardach A

    更新日期:2012-07-11 00:00:00

  • Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants.

    abstract:BACKGROUND:Chronic lung disease (CLD) remains a major problem in neonatal intensive care units. Persistent inflammation in the lungs is the most likely underlying pathogenesis. Corticosteroids have been used to either prevent or treat CLD because of their potent anti-inflammatory effects. OBJECTIVES:To determine if po...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001146.pub2

    authors: Halliday HL,Ehrenkranz RA,Doyle LW

    更新日期:2009-01-21 00:00:00

  • Non-speech oral motor treatment for children with developmental speech sound disorders.

    abstract:BACKGROUND:Children with developmental speech sound disorders have difficulties in producing the speech sounds of their native language. These speech difficulties could be due to structural, sensory or neurophysiological causes (e.g. hearing impairment), but more often the cause of the problem is unknown. One treatment...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009383.pub2

    authors: Lee AS,Gibbon FE

    更新日期:2015-03-25 00:00:00

  • Acupuncture for slowing the progression of myopia in children and adolescents.

    abstract:BACKGROUND:Myopia (near-sightedness or short-sightedness) is one of the three commonly detected refractive (focusing) errors. Acupuncture is the stimulation of acupuncture points by various methods including needle insertion and acupressure. It is often used by traditional Chinese medicine practitioners to treat myopia...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007842.pub2

    authors: Wei ML,Liu JP,Li N,Liu M

    更新日期:2011-09-07 00:00:00

  • Surgery versus thrombolysis for initial management of acute limb ischaemia.

    abstract:BACKGROUND:Both peripheral arterial thrombolysis and surgery can be used in the management of peripheral arterial ischaemia. Much is known about the indications, risks, and benefits of thrombolysis. However, whether thrombolysis works better than surgery for initial management of acute limb ischaemia remains unknown. T...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD002784.pub3

    authors: Darwood R,Berridge DC,Kessel DO,Robertson I,Forster R

    更新日期:2018-08-10 00:00:00

  • Corticosteroids for treating optic neuritis.

    abstract:BACKGROUND:Optic neuritis is an inflammatory disease of the optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this conditi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001430.pub3

    authors: Gal RL,Vedula SS,Beck R

    更新日期:2012-04-18 00:00:00

  • Donepezil for dementia due to Alzheimer's disease.

    abstract:BACKGROUND:Alzheimer's disease is the most common cause of dementia in older people. One of the aims of therapy is to inhibit the breakdown of a chemical neurotransmitter, acetylcholine, by blocking the relevant enzyme. This can be done by a group of chemicals known as cholinesterase inhibitors. OBJECTIVES:The objecti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001190.pub2

    authors: Birks J,Harvey RJ

    更新日期:2006-01-25 00:00:00

  • Care delivery and self-management strategies for children with epilepsy.

    abstract:BACKGROUND:In response to criticism that epilepsy care for children has little impact, healthcare professionals and administrators have developed various service models and strategies to address perceived inadequacies. OBJECTIVES:To assess the effects of any specialised or dedicated intervention for epilepsy versus us...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006245.pub4

    authors: Fleeman N,Bradley PM

    更新日期:2018-03-01 00:00:00

  • Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices.

    abstract:BACKGROUND:Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with conventional surgery (high ligation and stripping (HL/S)), proposed benefits include fewer complications...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005624.pub2

    authors: Nesbitt C,Eifell RK,Coyne P,Badri H,Bhattacharya V,Stansby G

    更新日期:2011-10-05 00:00:00

  • Gonadotrophin-releasing hormone analogues for pain associated with endometriosis.

    abstract:BACKGROUND:Endometriosis is a common gynaecological condition that frequently presents with the symptom of pain. The precise pathogenesis (mode of development) of endometriosis is unclear but it is evident that endometriosis arises by the dissemination of endometrium to ectopic sites and the subsequent establishment of...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000346

    authors: Prentice A,Deary AJ,Goldbeck-Wood S,Farquhar C,Smith SK

    更新日期:2000-01-01 00:00:00

  • Supplemental oxygen for the treatment of prethreshold retinopathy of prematurity.

    abstract:BACKGROUND:Oxygen has long been implicated in the pathogenesis of retinopathy of prematurity (ROP) and is rigorously monitored in today's neonatal intensive care units. Recent research using a feline model has shown an improvement in ROP outcome of kittens treated with supplemental oxygen. Current treatment for ROP by ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003482

    authors: Lloyd J,Askie L,Smith J,Tarnow-Mordi W

    更新日期:2003-01-01 00:00:00

  • Interventions targeted at women to encourage the uptake of cervical screening.

    abstract:BACKGROUND:Cervical cancer is the third most common cancer world-wide. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection. OBJECTIVES:To assess the effectiveness of interventions aimed at increasing uptake, ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002834

    authors: Forbes C,Jepson R,Martin-Hirsch P

    更新日期:2002-01-01 00:00:00

  • Pneumococcal vaccines for preventing otitis media.

    abstract:BACKGROUND:Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Long term effects of recurrent episodes of otitis media, rapid emergence of drug resistant bacteria associated with AOM worldwide and huge estimated direct and indirect annual costs associated with otitis media have e...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001480.pub2

    authors: Straetemans M,Sanders EA,Veenhoven RH,Schilder AG,Damoiseaux RA,Zielhuis GA

    更新日期:2004-01-01 00:00:00

  • Influenza vaccines for preventing acute otitis media in infants and children.

    abstract:BACKGROUND:Acute otitis media (AOM) is one of the most common infectious diseases in children. It has been reported that 64% of infants have an episode of AOM by the age of six months and 86% by one year. Although most cases of AOM are due to bacterial infection, it is commonly triggered by a viral infection. In most c...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010089.pub3

    authors: Norhayati MN,Ho JJ,Azman MY

    更新日期:2017-10-17 00:00:00