Tailoring treatment for women with heavy menstrual bleeding

Around 30% of women experience heavy menstrual bleeding during their reproductive years and it is a common reason for consulting a gynecologist. Heavy menstrual bleeding has a negative impact on quality of life as it negatively influences physical activity, psychosocial well-being and sexual life. Two frequently used treatments are the levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena®) and endometrial ablation (Novasure®). This dissertation focuses on the effectiveness of the LNG-IUS compared to endometrial ablation, whereby cost-effectiveness is also investigated. Furthermore, it provides insight into patient's preferences and it investigates if certain women have a higher risk of treatment failure with either the LNG-IUS or endometrial ablation. The results of the studies in this dissertation contribute to a tailor-made treatment for women with heavy menstrual bleeding.