What is the indicated initial surgical management for dysfunctional uterine bleeding?

• A. Hysterectomy
• B. Endometrial ablation
• C. D&C
• D. Medical management with tranexamic acid

Answer: (C)

Dilation and curettage is used as the initial surgical approach for dysfunctional uterine bleeding because it both quickly reduces the bleeding by removing the endometrial lining and provides tissue for pathology to rule out endometrial disease. This procedure offers rapid hemostasis and diagnostic information, which is especially important when abnormal uterine bleeding could be due to conditions like endometrial hyperplasia or cancer. It’s less invasive than definitive surgical options and can be performed after medical therapies have been considered or tried.

Endometrial ablation is a definitive treatment for heavy bleeding but is chosen for patients who no longer desire fertility and want a longer-term solution, not as the first surgical step. Hysterectomy is the most invasive definitive option and is reserved after other therapies fail or are unsuitable. Medical management with tranexamic acid addresses bleeding without surgery, so it isn’t the surgical choice here.