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This article doesn’t mention that 13 to 20 percent of women with heavy menstrual periods have a common but often undiagnosed bleeding disorder called von Willebrand disease. Because this disorder is often treatable by medication, many of the hysterectomies performed to stop bleeding could be prevented. The National Hemophilia Foundation and its local chapters are making a nationwide effort to raise awareness about von Willebrand disease.

Cathy Cornell
New England Hemophilia Association
Dedham, Mass.

Your article fails to mention newer therapies. Many women with heavy bleeding who do not have malignant disease or fibroids are candidates for endometrial ablation procedures, in which the uterine lining is destroyed without removal of the uterus. Even patients with fibroids may be candidates for embolization, targeted ultrasound, or other emerging therapies.

Robert D. Sheeler
Mayo Clinic
Rochester, Minn.

A good deal more could be learned if similar studies were conducted in societies where hysterectomies aren’t as readily available as they are in the United States and Finland. The fact that hysterectomies are perhaps the more socially acceptable option in wealthy industrial societies may mean little in terms of their actual, medical effectiveness.

James M. Bryant
Riverside Municipal Museum
Riverside, Calif.