Summary of findings 2. Surgery versus LNG‐IUS for women with heavy menstrual bleeding.
| Surgery versus LNG‐IUS for women with heavy menstrual bleeding | ||||||
| Population: women with heavy menstrual bleeding Intervention: surgery Comparison: LNG‐IUS | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with LNG‐IUS | Risk with Surgery | |||||
| Objective control of bleeding: menstrual loss under 80 ml per cycle LNG‐IUS versus hysterectomy At 1 year |
897 per 1000 | 995 per 1000 (941 to 1000) | RR 1.11 (1.05 to 1.19) | 223 (1 RCT) | ⨁⨁⨁◯ MODERATE 1 | — |
| Subjective control of bleeding: PBAC no more than 75 per cycle Endometrial resection or ablation versus LNG‐IUS At 1 year |
767 per 1000 | 912 per 1000 (820 to 1000) | RR 1.19 (1.07 to 1.32) | 281 (5 RCTs) | ⨁⨁◯◯ LOW 1 2 | — |
| Satisfaction rate: surgery versus LNG‐IUS Endometrial ablation versus LNG‐IUS At 1 year |
630 per 1000 | 693 per 1000 (617 to 781) | RR 1.10 (0.98 to 1.24) | 332 (5 RCTs) | ⨁⨁◯◯ LOW 1 2 | — |
| Satisfaction rate: surgery versus LNG‐IUS Endometrial ablation versus LNG‐IUS At 2 years |
894 per 1000 | 832 per 1000 (724 to 966) | RR 0.93 (0.81 to 1.08) | 117 (2 RCTs) | ⨁⨁◯◯ LOW 1 2 | — |
| Proportion of women with adverse events Endometrial ablation versus LNG‐IUS. At one year |
559 per 1000 | 285 per 1000 (201 to 414) | RR 0.51 (0.36 to 0.74) | 201 (3 RCTs) | ⨁⨁⨁◯ MODERATE 2 | — |
| *The risk in the intervention group (and its 95% confidence interval) is based on the median risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LNG‐IUS: levonorgestrel‐releasing intrauterine device; PBAC: pictorial blood loss assessment chart; RCT: randomised controlled trial; RR: risk ratio; OR: odds ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1Confidence intervals compatible with benefit in the surgical arm or no clinically meaningful difference between the groups. 2Studies unblinded.