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Surgical treatment for menorrhagia — traditionally with hysterectomy but, more recently, with endometrial ablation — generally is offered when medical treatment is ineffective, poorly tolerated, or contraindicated. Insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) can diminish heavy menstrual bleeding. In a manufacturer-sponsored meta-analysis of six randomized trials from six countries, the LNG-IUS was compared with endometrial ablation for control of menorrhagia.
The six trials involved 196 women who underwent LNG-IUS insertion and 194 who underwent either first-generation (manual hysteroscopy) or second-generation (thermal balloon) endometrial ablation. At 6, 12, and 24 months, no significant differences in menstrual b…