Heavy menstrual bleeding: assessment and management

Recommendation ID: NG88/4
Question: Hysteroscopic removal of submucosal fibroids compared with other uterine-sparing treatments for HMB:- Is hysteroscopic removal of submucosal fibroids more effective and cost-effective than other uterine-sparing treatments for the management of HMB?
Any explanatory notes (if applicable): Why this is important:- HMB is thought to be caused by submucosal fibroids in around 15% of women. Such fibroids are amenable to minimally invasive surgical removal ('hysteroscopic myomectomy'), avoiding the need for surgical incision. Non-comparative data have reported improvement in HMB symptoms and the avoidance of further pharmacological or surgical treatment in 70 to 80% of women treated with hysteroscopic myomectomy.
Specific hysteroscopic surgical skills are necessary to optimise surgical success and minimise complications. However, recent advances in endoscopic technologies have made hysteroscopic myomectomy potentially safer and more feasible.
A randomised controlled trial comparing this technique with long-term pharmacological therapy or more invasive surgical intervention would provide information on long-term outcomes.

Source guidance details

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	31/03/2018