Medicine or Surgery (Ms): A Randomized Clinical Trial Comparing Hysterectomy and Medical Treatment in Premenopausal Women with Abnormal Uterine Bleeding: Varner,

Background: Hysterectomy may be over-used as treatment for abnormal uterine bleeding due to benign causes in reproductive women. Medical therapies are an alternative, and there is a need for randomized trials comparing the outcomes of these approaches. Design: Reproductive age women who continued to have bothersome abnormal uterine bleeding after cyclic hormonal treatment with medroxyprogesterone acetate (MPA; 10-20 mg for 10-14 days/month) for three to five months were invited to participate in a randomized trial of hysterectomy versus other medical therapies. Participating gynecologists were free to choose the particular surgical (transabdominal or transvaginal) or medical (generally oral contraceptives and/or a prostaglandin synthetase inhibitor) approaches. Outcomes during two years of follow-up include quality of life (primary), sexual function, clinical effectiveness and cost. Results: We screened 1557 women to find 413 who began three to five months o