If definitive surgical treatment is intended, the likely outcomes and complications should be discussed with the woman beforehand. Recommendations for future research Validated and widely accepted rating scales are required for menorrhagia, dysmenorrhoea and premenstrual syndrome, for clinical purposes and for research into aetiology and treatment. Research is needed to understand the process whereby patients make decisions about the balance of risk and benefit. The role of pelvic ultrasound in the investigation of menstrual disorders should be defined prospectively. Further work is required to confirm that the major action of antifibrinolytic agents is confined to the endometrium itself.
Research is required to develop new treatments for the management of menstrual disorders.
Any new medical and surgical procedures must be critically assessed against current clinical practice. The relationship between symptoms and the site and size of fibroids requires clarification, as does the efficacy of treatment according to these factors. It is essential to evaluate local mechanisms that regulate uterine function in order to provide a valid basis for the development of novel medical approaches to management, thereby improving the choice of therapy available to women. Stereological methods should be used to provide a comprehensive anatomical framework upon which to lay the new physiological and molecular information. New tools such as non-invasive imaging techniques, confocal microscopy and functional genomics should shed further light on the mechanisms controlling morphological and functional changes in the endometrium.