The treatment of AUB has undergone a remarkable evolution over the last ten years. Women with a diagnosis of Dysfunctional Uterine Bleeding (DUB) should be considered for the Mirena IUS. This is a useful device for women with heavy periods, both with and without pain and other associated symptoms. It can be used as a first line therapy for those with regular periods that also require contraception.

In over ten studies it has been shown to reduce objective menstrual loss by 90% and about 30% of women will become amenorrheic by the end of the first year of use. The default rate is about 10-15% in women who generally develop progestogenic side-effects. A trial run with the progestogen only pill prior to inserting Mirena is useful in identifying potential defaulters.

In women with intrauterine pathology the option of operative hysteroscopy is the preferred option nowadays with direct visualisation and removal of polyp. This can be achieved on an outpatient basis with the latest range of fine operating hysteroscopes without the need for general anaesthesia.

• Sonohysterography is an outpatient procedure which does not require any anaesthesia and can be performed at the same time as the transvaginal USS
  
• The diagnostic accuracy of SH is comparable to diagnostic hysteroscopy
  
• SH avoids the need for diagnostic hysteroscopy in 67% of cases
  
• In a one-stop clinic a diagnosis is obtained in over 90% of women and in the vast majority of these women treatment at the same visit with Mirena or operative hysteroscopy is now a realistic option

For more information contact Joseph Aquilina