What do systematic reviews say?

Second‐generation endometrial ablation vs first‐generation endometrial ablation

It is very uncertain whether overall analyses: second‐generation endometrial ablation changes bleeding compared with first‐generation endometrial ablation (very low certainty).

• Endometrial resection and ablation techniques for heavy menstrual bleeding 2019 · Cochrane Headline outcomes only
  RR 0.99 [0.78, 1.27]
  12 studies · 2145 participants
  Very low

Endometrial resection or ablation vs unspecified (or at surgeon's discretion) route of hysterectomy

Endometrial resection/ablation may leads to lower effectiveness Proportion of women with perception of improvement of… compared with unspecified (or at surgeon's discretion) route of hysterectomy (low certainty).

• Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding 2021 · Cochrane Headline outcomes only
  RR 0.89 [0.83, 0.95]
  2 studies · 403 participants
  Low

Endometrial resection or ablation vs open hysterectomy

Endometrial resection or ablation probably leads to lower effectiveness Woman's perception (proportion with improvement in… compared with open hysterectomy (moderate certainty).

• Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding 2021 · Cochrane Headline outcomes only
  RR 0.9 [0.84, 0.95]
  2 studies · 247 participants
  Moderate

Surgery vs LNG‐IUS

Surgery may leads to higher subjective control of bleeding: PBAC no more than 75 per cycle… compared with LNG‐IUS (low certainty).

• Surgery versus medical therapy for heavy menstrual bleeding 2016 · Cochrane Headline outcomes only
  RR 1.19 [1.07, 1.32]
  5 studies · 281 participants
  Low

LNG‐IUS vs endometrial ablation

• Progestogen‐releasing intrauterine systems for heavy menstrual bleeding 2020 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 122 participants
  Very low