Surgery versus medical therapy for heavy menstrual bleeding

Area of Science:

• Gynecology
• Surgical and Medical Treatments
• Women's Health

Background:

• Heavy menstrual bleeding (HMB) significantly impacts women's quality of life.
• Management of HMB is subjective, based on individual tolerance of bleeding and discomfort.
• Treatment options include oral medications, hormone-releasing intrauterine systems (LNG-IUS), and surgical interventions (conservative surgery, hysterectomy).

Purpose of the Study:

• To compare the effectiveness, safety, and acceptability of surgical versus medical therapies for HMB.

Main Methods:

• Systematic review of controlled randomized trials comparing surgery (conservative surgery, hysterectomy) with medical therapy (oral, LNG-IUS) for HMB.
• Searched multiple databases (Cochrane, MEDLINE, EMBASE, etc.) and contacted experts.
• Two reviewers independently assessed trial quality and extracted data using odds ratios and weighted mean differences.

Main Results:

• Endometrial resection was more effective and had fewer side effects than oral medication.
• At one year, LNG-IUS showed no significant difference in satisfaction or quality of life compared to surgery, but conservative surgery had fewer adverse effects.
• Conservative surgery was more effective than LNG-IUS at one year, but long-term differences were not significant; hysterectomy resolved bleeding but carried risks.

Conclusions:

• Surgery offers superior one-year bleeding control compared to medical treatments for HMB.
• LNG-IUS demonstrates comparable long-term quality of life benefits and potentially similar bleeding control to conservative surgery.
• Oral medications are suitable for a limited number of women with HMB long-term.