Update on treatment of menstrual disorders

•There is evidence from well designed randomised controlled trials that modern medical and conservative surgical therapies (including endometrial ablation) are effective treatments for heavy menstrual bleeding for many women.•Submucous fibroids may be resected directly via the hysteroscope, reducing menstrual bleeding, although data are available only from case series.•Endometriosis is common, may also occur in young women and may present with atypical or non-cyclical symptoms; conservative laparoscopic surgery increases fecundity and reduces dysmenorrhoea and dyspareunia.•Randomised trials of the levonorgestrel intrauterine system in women with menorrhagia have shown that hysterectomy can be avoided in 80% of cases, and that this system is an effective therapy for menorrhagia.•The levonorgestrel intrauterine system may also be useful for managing symptoms of endometriosis, adenomyosis and endometrial hyperplasia, based on observational data.