Abnormal uterine bleeding: avoid the rush to hysterectomy.

136 VOL 58, NO 3 / MARCH 2009 THE JOURNAL OF FAMILY PRACTICE several occasions. She says she often feels tired, and worries that she may be anemic. Preserving fertility is not a concern; her husband has had a vasectomy. On exam she is without orthostasis and appears well. Her uterus is topnormal size, nontender, and there are no adnexal masses or cervical or vaginal abnormalities. You note a normal Pap at your offi ce 5 months ago. Her offi ce hemoglobin is 9.8 mg/dL. She asks you to refer her to a gynecologist for a hysterectomy because she “just can’t take it anymore.” Her heavy menses are disrupting her life. Since she does not want any more children, she feels that if someone could “just take it out,” her problem would be solved. But she isn’t really enthusiastic about a hysterectomy because her life is too busy to allow time for a lengthy recovery. You explain that there are a number of options you’d like her to consider fi rst. Then you review the options and some of the research behind them, having recently read an article on evidence-based therapy for abnormal uterine bleeding.

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