Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy.
OBJECTIVE
To investigate patient preferences for endometrial ablation and a levonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectomy in the treatment of dysfunctional uterine bleeding.


METHODS
Comparative study based on structured interviews.


METHODS
A large teaching hospital with 500 beds in the Netherlands.


METHODS
Ninety-six patients who were scheduled for endometrial ablation, 25 patients who were scheduled for hysterectomy, and 23 patients who were scheduled for a levonorgestrel-releasing IUD were interviewed. All of the women had dysfunctional uterine bleeding.


METHODS
Patients were asked to state their most significant complaints and their reasons for choosing a particular treatment. Subsequently, the preference for endometrial ablation and a levonorgestrel-releasing IUD as alternatives to hysterectomy was assessed during a structured interview. Women were informed about the advantages and disadvantages of all three treatment options. Patients rated their preferences according to different hypothetical success rates. The success rates after endometrial ablation and levonorgestrel-releasing IUD were varied until patients found an acceptable treatment outcome.


METHODS
Patient preference of endometrial ablation and the levonorgestrel-releasing IUD over hysterectomy.


RESULTS
The main reason for the treatment of choice differed between the three groups. Most of the patients in the hysterectomy group wanted a definite solution to their problems, whereas patients in the levonorgestrel-releasing IUD group and in the ablation group put greater emphasis on a minimally invasive intervention with or without a short hospital stay. In women undergoing ablation, 70% of the patients preferred this treatment and the levonorgestrel-releasing IUD to hysterectomy in cases in which the success rate of noninvasive treatment was presumed to be 50%. In women having a levonorgestrel-releasing IUD inserted, 95% of the patients preferred this approach over hysterectomy in cases in which the success rate of this device was presumed to be 50%, whereas 35% of patients preferred ablation over hysterectomy in cases in which the success rate of ablation was presumed to be 50%. In women undergoing hysterectomy, 30% would have opted for ablation and 45% would have opted for a levonorgestrel-releasing IUD in cases in which success rates were 50%. Of patients who opted for hysterectomy, however, 60% stated that they would have preferred a noninvasive treatment if the success rate of this type of treatment were >80%.


CONCLUSIONS
A majority of the patients who had dysfunctional uterine bleeding and who were scheduled for an endometrial ablation or a levonorgestrel-releasing IUD were inclined to take a risk of 50% likelihood of treatment failure to avoid a hysterectomy. As a consequence, research of treatment for dysfunctional uterine bleeding should focus on this 50% success level.
Bourdrez
Petra
P
Department of Obstetrics and Gynaecology, Vie Curi Medical Center for Northern Limburg, Limburg, The Netherlands. P.Bourdrez@12move.nl
Bongers
Marlies Y
MY
Mol
Ben W J
BW
D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage*; D016013:Likelihood Functions; D008875:Middle Aged; D017060:Patient Satisfaction; D017211:Treatment Failure; D014592:Uterine Hemorrhage / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel