Surgery versus medical therapy for heavy menstrual bleeding

Area of Science:

• Gynecology
• Surgical Interventions
• Pharmacological Treatments

Background:

• Heavy menstrual bleeding (HMB) significantly impacts women's quality of life.
• Management is subjective, with options including oral medication, hormone-releasing intrauterine systems (LNG-IUS), and surgical procedures like hysterectomy or endometrial ablation.

Purpose of the Study:

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

Main Methods:

• Systematic review of controlled randomized trials comparing surgery (conservative or hysterectomy) with medical therapy (oral or LNG-IUS) for HMB.
• Data extraction and quality assessment by two independent reviewers.

Main Results:

• Surgery, especially hysterectomy, demonstrated greater reduction in bleeding compared to oral medication. Endometrial resection was more effective and safer than oral medication in the short term.
• LNG-IUS showed comparable quality of life improvements to conservative surgery or hysterectomy at one year, though conservative surgery had fewer adverse effects.
• Hysterectomy effectively stopped bleeding but carried risks of serious complications; long-term evidence for all treatments remains limited and inconsistent.

Conclusions:

• Surgical options, particularly hysterectomy, offer superior bleeding control for HMB compared to medical treatments within one year.
• LNG-IUS provides comparable quality of life benefits to surgery, with fewer side effects than conservative surgery.
• Long-term comparative data are weak, and oral medications are suitable for a minority of women.