[Menorrhagia: uterine extirpation remains the final option]

The conclusion of a recent cost-effectiveness analysis shows that hysterectomy is the preferred strategy in women with heavy menstrual bleeding. However, this conclusion is not directly applicable in general daily practice. Deciding about certain treatment is not only based on the best-available treatment but also on the experience of a physician and more importantly, on the patient's preferences. For heavy menstrual bleeding, it is known that patients are willing to accept a treatment failure rate of up to 50% in order to avoid hysterectomy. Adequate knowledge on the different treatment options in terms of success, effectiveness, and quality of life are necessary to be able to give each patient solid advice regarding the different treatment options. Patients' preferences were not taken into account in the recent cost-effectiveness analysis of the treatment of heavy menstrual bleeding; therefore, the results of the study are not directly applicable in daily practice.