Length of follow-up ranged from four to 60 months.
Seven RCTs (six studies rated fair quality and one rated good) with 1,167 patients compared hysterectomy with endometrial ablation and reported superior long-term pain (low strength of evidence) and bleeding control (moderate strength of evidence) for hysterectomy.
One RCT (rated good quality) with 236 patients compared hysterectomy with levonorgestrel inter-uterine system and reported superior bleeding control (moderate strength of evidence) for hysterectomy.
One RCT (rated good and fair quality for different outcomes) with 63 patients compared hysterectomy with medical treatment and reported no differences on bleeding control, quality of life, pain, sexual health or satisfaction.
All less invasive treatment options were associated with a lower risk of adverse events but higher risk of additional treatments than hysterectomy. No other differences between treatments were found.