A Cochrane review (abstract , review ) included 15 studies with a total of 1 289 patients. Surgical interventions included hysterectomy and endometrial resection or ablation. In comparisons of oral medication versus surgery, 58% of women randomised to medical treatment had received surgery by two years. Compared to oral medication, endometrial resection was significantly more effective in controlling bleeding (at 4 months: RR 2.66, 95% CI 1.94 to 3.64, 1 study; n= 186; NNT = 2, 95% CI 2 to 3) and hysterectomy resulted in significantly greater improvements in mental health (at 6 months: P = 0.04, 1 study).
In comparisons of levonorgestrel-releasing intrauterine device (LNG-IUS) versus conservative surgery or hysterectomy, there was no statistically significant difference in satisfaction rates or quality of life at one year, though adverse effects were significantly less likely with conservative surgery (RR 0.51, 95% CI 0.36 to 0.74, 3 studies; NNT = 4, 95% CI 3 to 7). Conservative surgery was significantly more effective than LNG-IUS in controlling bleeding at one year (objective control: RR 1.11 (1.05 to 1.19); 1 trial, n=223 and subjective control or PBAC: RR 1.19, 95% CI 1.07 to 1.32, 5 studies; n=281; NNT = 7, 95% CI 5 to 19). Two other small trials with longer follow-up found no difference or favoured LNG-IUS, but trials had methodological shortcomings. Hysterectomy stopped all bleeding but caused serious complications for some women.
See also another Cochrane evidence summary on the topic .
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