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Acta Medica Medianae
Vol. 45
Number 3, July, 2006
UDK 61
YU ISSN 0365-4478

Srdjan Pesic

Institute of Farmacology Faculty of Medicine

81 dr Zoran Djindjic Street

18000 Nis, Serbia

Phone:+381 18 226712



Copyright 2006 by Faculty  of Medicine, University of Nis


Srdjan Pesic*, Milan Stefanovic** and Valentina Nikolic*

Institute of Farmacology Faculty of Medicine of Nis *

Ginecology and Obstethsics Clinic, Clinical center of Nis **


The range of alternatives to hysterectomy includes ‘expanded’ oral medical regimens, the levonorgestrel-releasing intrauterine system (LNG-IUS), a wide range of endometrial ablative techniques, and where fibroids are the primary pathology—myomectomy and uterine artery embolization. Since the research has shown that hysterectomy is a highly effective treatment, these alternatives must be assessed against the recognized high satisfactory rates and improved quality of life reported following hysterectomy. Additional issues that would also need to be addressed include complication rates, side-effects, and cost-effectiveness. For women with prolonged abnormal uterine bleeding, recent research suggests that hysterectomy is significantly superior to an expanded medical treatment regimen for health-related quality-of-life measures. Satisfaction with the treatment, and health-related quality of life and psychosocial well-being, are reportedly similar between hysterectomy and the LNG-IUS, but the latter has the advantage of reduced cost. Endometrial ablation reduces menstrual blood flow, but its benefits relative to hysterectomy lessen over time. No large-scale studies have adequately compared uterine artery embolization or myomectomy to hysterectomy. Perhaps, the most telling finding from recent research with respect to the place of alternative therapies to hysterectomy is that the existence or advent of these alternatives has not reduced hysterectomy rates, but merely increased treatment options and interventions for excessive menstrual loss. Acta Medica Medianae 2006; 45(3):43-52.

 Key words: abnormal uterine bleeding, menorrhagia, hysterectomy, quality of life, levonorgestrel intrauterine system