f life at four to six months. In these trials, women who were not satisfied with their results were allowed to change treatments, and by the two-year follow-up, 58 percent of women randomized to oral drugs had elected to have surgery. At that point, differences in quality of life and symptoms were no longer significant.

Five trials compared a hormone-releasing IUD to conservative surgery, and in these trials, surgery generally resulted in better control of bleeding than the IUD. However, improvements in quality of life were similar in the two groups of women, and those who received the IUD were as likely to be satisfied with their outcome as women who underwent conservative surgery.

Health-related quality of life and satisfaction rates were also equivalent in the single head-to-head comparison between hysterectomy and the IUD. In that study, 58 percent of women randomized to receive the IUD were able to avoid hysterectomy. Moreover, the costs associated with the IUD were about 40 percent lower than for hysterectomy after five years of follow-up.

Antoni Duleba, M.D., of Yale University School of Medicine, said the review confirms what many gynecologists have long suspected — that oral drugs generally are not all that effective.

“However, this does not mean that one should not try these treatments,” Duleba said. “As effectiveness increases, invasiveness increases. For some patients, the best treatment is going to be medical, and those patients can avoid the risks of surgery.”

In the United States, oral drugs for heavy menstrual bleeding include birth control pills, progesterone analogs and nonsteroidal anti-inflammatory drugs. The IUD that was evaluated in six of the eight trials in this review — the levonorgestrel intrauterine system, or LNG-IUS — has been in use in Europe for more than a decade and was approved by the U.S. Food and Drug Administration in 2000.

Hysterectomy has been considered the definitive
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