Commentary: promising results but wider recruitment needed.

Concerns about high rates of hysterectomy have increased interest in alternative surgical and medical treatments for menorrhagia. Hysteroscopic procedures that ablate and resect the endometrium without hysterectomy have been widely adopted but have increased, rather than decreased, the surgical workload in the UK. In addition, most patients prefer surgery to the available medical treatments. A study of the use of levonorgestrel-releasing IUD for treatment of menorrhagia found that more than 80% of women awaiting hysterectomy found this an attractive and effective alternative. However, future research will have to determine the attractiveness of this treatment to patients waiting for a minimally invasive surgical treatment. Alternative trial designs, such as the use of partially randomized patient preference trials, may be needed because it is not possible to create a blind control group in randomized trials of the use of the medicated IUD. The study findings, however, clearly support the use of the levonorgestrel IUD for treatment of menorrhagia. Further research will be required to evaluate long-term clinical effectiveness, cost effectiveness, and patient satisfaction.