title: Clinical practice guideline for abnormal uterine bleeding: hysterectomy versus alternative therapy.
abstract: OBJECTIVE
  To develop recommendations in selecting treatments for abnormal uterine bleeding (AUB).
  
  
  METHODS
  Clinical practice guidelines.
  
  
  METHODS
  Randomized clinical trials compared bleeding, quality of life, pain, sexual health, satisfaction, the need for subsequent surgery, and adverse events between hysterectomy and less-invasive treatment options.
  
  
  METHODS
  Women with AUB, predominantly from ovulatory disorders and endometrial causes.
  
  
  METHODS
  On the basis of findings from a systematic review, clinical practice guidelines were developed. Rating the quality of evidence and the strength of recommendations followed the Grades for Recommendation Assessment, Development, and Evaluation system.
  
  
  RESULTS
  This paper identified few high-quality studies that directly compared uterus-preserving treatments (endometrial ablation, levonorgestrel intrauterine system and systemically administered medications) with hysterectomy. The evidence from these randomized clinical trials demonstrated that there are trade-offs between hysterectomy and uterus-preserving treatments in terms of efficacy and adverse events.
  
  
  CONCLUSIONS
  Selecting an appropriate treatment for AUB requires identifying a woman's most burdensome symptoms and incorporating her values and preferences when weighing the relative benefits and harms of hysterectomy versus other treatment options.
authors.affiliation: University Medical Group, Greenville Hospital Systems, Greenville, South Carolina 29605, USA. twheeler@ghs.org
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Wheeler
authors.forename: Miles
authors.initials: M
authors.lastname: Murphy
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gala
authors.forename: Blair
authors.initials: B
authors.lastname: Washington
authors.forename: Linda
authors.initials: L
authors.lastname: Bradley
authors.forename: Katrin
authors.initials: K
authors.lastname: Uhlig
mesh_terms: D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D055356:Endometrial Ablation Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D010049:Ovarian Diseases / Q000150:complications; D057240:Patient Preference; D014591:Uterine Diseases / Q000150:complications; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel