Key content Heavy menstrual bleeding remains a major problem for some women. Hysterectomy is the leading treatment for this condition but it is recognised to have some serious complications. First‐generation endometrial ablation techniques have a steep learning curve and are carried out under hysteroscopic visualisation. Second‐generation techniques are simpler and have lower complication rates, lower analgesia requirements and potential for outpatient use. Individual assessment is important in deciding the route and method of treatment for heavy menstrual bleeding, taking clinical factors into consideration. Learning objectives To know about the various options currently available for endometrial ablation. To learn about the clinical application, advantages and limitations of various methods of endometrial ablation. To be able to make an informed choice when deciding which modality to use. Ethical issues Intense competition will continue to drive device manufacturers to make claims of effectiveness based on poor‐quality evidence. All users have a responsibility to be well informed and to offer evidence‐based advice to women. Please cite this article as: Justin W, Ibraheim M, Bagtharia S, Haloob R. Current minimal access techniques in the treatment of heavy menstrual bleeding. The Obstetrician & Gynaecologist 2007;9:223–232.

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Leiomyomas are benign smooth muscle tumors which can be uterine or extrauterine. Extrauterine leiomyomas are uncommon. In this article, we report a case of large retroperitoneal fibroid in 26 year old female who presented with sudden onset of severe right iliac fossa pain. Her medical, surgical and gynaecological history was insignificant. Provisional diagnosis, based on investigations, was ovarian mass. Intra operatively huge pelvic retroperitoneal mass was observed. Pathological examination demonstrated benign leiomyoma.

This study aims to compare morbidity indicators between twins and triplets. This was a retrospective, observational study, and involved a review of twins and triplets born in Basildon Hospital between 1991 and 2000. The main outcome measures were mean birth weight, gestational age at delivery, mode of delivery and length of stay in the intensive care unit. The mean birth weight is comparable between twins and triplets (1.877 kg at 33+4 weeks of gestation vs. 1.905 kg at 34+4 weeks of gestation). Triplets stayed a longer period in the intensive care baby unit. In this study birth weight in multiple pregnancies was as expected for gestational age. Triplets required longer neonatal intensive care.

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