Women's preferences for the levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding

Marian J. van den Brink*, Pleun Beelen, Malou C. Herman, Nathalie J. J. Claassen, Marlies Y. Bongers, Peggy M. Geomini, Jan Willem van der Steeg, Lotte van den Wijngaard, Madelon van Wely

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: Women's preferences for treatment of heavy menstrual bleeding (HMB) are important in clinical decision-making. Our aim was to investigate whether women with HMB have a preference for treatment characteristics of the levonorgestrel intrauterine system (LNG-IUS) or endometrial ablation and to assess the relative importance of these characteristics.

Study Design: A discrete choice experiment was performed in general practices and gynaecology outpatient clinics in the Netherlands. Women with HMB were asked to choose between hypothetical profiles containing characteristics of LNG-IUS or endometrial ablation. Characteristics included procedure performed by gynaecologist or general practitioner; reversibility of the procedure; probability of dysmenorrhea; probability of irregular bleeding; additional use of contraception; need to repeat the procedure after five years; and treatment containing hormones. Data were analysed using panel mixed logit models. The main outcome measures were the relative importance of the characteristics and willingness to make trade-offs.

Results: 165 women completed the questionnaire; 36 (22%) patients were recruited from general practices and 129 (78%) patients were recruited from gynaecology outpatient clinics. The characteristic found most important was whether a treatment contains hormones. Women preferred a treatment without hormones, a treatment with the least side effects, and no need for a repeat procedure or additional contraception. Women completing the questionnaire at the gynaecology outpatient clinic differed from women in primary care in their preference for a definitive treatment to be performed by a gynaecologist.

Conclusions: Whether or not a treatment contains hormones was the most important characteristic influencing patient treatment choice for HMB. Participants preferred characteristics that were mostly related to endometrial ablation, but were willing to trade-off between characteristics. (C) 2018 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)143-147
Number of pages5
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Publication statusPublished - Sept 2018


  • Discrete choice experiment
  • Endometrial ablation
  • Heavy menstrual bleeding
  • Levonorgestrel intrauterine system
  • Patient preference

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