How do New Zealand gynaecologists treat menorrhagia?

The objectives of this study were to establish the criteria and technique that New Zealand gynaecologists use for endometrial sampling for women with menorrhagia, and to establish the preferred medical therapy for menorrhagia. A postal survey of all practising gynaecologists in New Zealand was undertaken. Questions were asked regarding which women with menorrhagia should have an endometrial biopsy, what sampling method they used, and their first, second and third line medical treatments. There were 68 replies (48% response rate). There was no general agreement on the mean age at which women with menorrhagia should have an endometrial sample. Forty-six percent preferred hysteroscopy to sample the endometrium, and 41% preferred a pipelle suction curette. The most favoured first-line choice used to treat menorrhagia was luteal phase progestogens (54%). The most-favoured second choice was the nonsteroidal antiinflammatory drugs (NSAIDs), and the most favoured third choice was danazol. The results from this study suggested that protocols need to be developed in order to prevent women with menorrhagia from being inappropriately investigated or suboptimally treated. It is possible that the high hysterectomy rate in New Zealand could be reduced if gynaecologists were to use more effective treatment earlier in the clinical presentation of menorrhagia.