Staying on the subject of unnecessary procedures, half of all hysterectomies are due to heavy menstrual bleeding. Even many in medicine accept this is a very heavy-handed response to a problem that should be solved in a less traumatic way, but nobody seems to know what that should be.

Heavy menstrual bleeding, or menorrhagia, can end up as a self-fulfilling problem. Around 30 per cent of all women believe they have heavy menstrual bleeding each month, but only half of these actually lose so much blood that it's considered by doctors to be a problem.

Nonetheless, some of these women will start receiving medical treatment - possibly because they feel the doctor should do something - even though there is no problem to resolve. Treatment often begins with drug therapy, such as an NSAID (non-steroidal, anti-inflammatory drug), an antifibrinolytic or hormone therapy.

If this therapy doesn't help (and there's always a chance that it won't if there's not a problem in the first place), then the doctor may suggest surgery, from a minor procedure such as first- and second-generation ablation methods to the dreaded hysterectomy.

Hysterectomy stops 90 per cent of all cases of heavy bleeding, but it comes with a very high price of serious, yet all-too-common, reactions and, more rarely, death.

Despite new guidelines being released to practitioners in the UK and New Zealand in the late 1990s, which urged doctors to use one of the less invasive ablation procedures, numbers of hysterectomies that have been performed since then have not fallen.

Yet it shouldn't be like that. When researchers sent 100 clinics information about non-interventionist strategies for heavy menstrual bleeding, virtually none of the women who attended one of those clinics later went on to have a hysterectomy.

As we say, it doesn't have to be that way.

(Source: British Medical Journal, 2003; 327: 1243-4).