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Heavy menstrual bleeding (HMB) affects approximately 10% to 30% of women of reproductive age and is often treated conservatively with insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) or endometrial ablation/ resection (EA). The LNG-IUS induces atrophy of endometrial tissue, whereas EA is a minimally invasive, uteruspreserving procedure that destroys endometrial tissue and superficial myometrium. Approximately 12% to 25% of the women require reintervention with additional surgery 2 to 5 years after EA treatment. Treatment failure after EA presents with persistent or recurrent vaginal bleeding thought to occur because of ongoing bleeding from areas of untreated or regenerated endometrium and can require hysterectomy. Introduction of an LNG-IUS after EA could suppress regeneration and nonablated endometrial tissue resulting in a reduction of symptoms and lower hysterectomy rate.This systematic review aimed to determine whether combined treatment with LNG-IUS insertion immediately after EA can lower the reintervention rate among women with HMB. A systematic search was conducted using the Medline, EMBASE, and Cochrane Library databases from inception through September 16, 2020. Studies reporting the results of this combined treatment with orwithout a control group were included. The primary study outcome was hysterectomy rate after treating with EA and LNG-IUS. Secondary outcomes included reintervention rate, reasons why women required additional treatment, removal rate of LNG-IUS, bleeding pattern, patient satisfaction, and adverse events. Included studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for nonrandomized cohort studies.A total of 7 studies were included in this systematic review, of which 4 were historic cohort studies with a control group, 2 were historic cohort studies without a control group, and 1 was case series. A total of 747 women were included, 472 of whom were treated withEA and LNG-IUS, with a follow-up duration between 6 and 55.2 months. The 4 controlled studies showed a hysterectomy rate in the combined treatment group between 0% and 11%, whereas treatment with EA alone showed a rate between 9.4% and 24%. The 4 studies investigating nonhysteroscopic EA plus LNG-IUS showed hysterectomy rates between 0% and 1%. Four studies reported reintervention rates, with 3 controlled studies showing a lower reintervention rate among the combined treatment cohort (0%8.7%) compared with the EA alone cohort (19%-29.2%). Reintervention rate was significantly lower at 12 and 24 months after combined treatment compared with EA alone. Patient satisfaction was reported in 3 studies, with satisfaction rates in favor of the combined treatment group. The adverse event rate associated with LNG-IUS after combined treatment resulting in removal was 1.6%.The results of this review show that hysterectomy rate after combined treatment with EA and LNG-IUS seems to vary between 0% and 11% compared with a rate between 9.4% and 24% associated with EA alone. The complication rate between the 2 management options seemed the same, whereas the bleeding profile and patient satisfaction both favored the combined treatment group. The data from included studies are limited by its observational nature with low methodological quality, and high-quality prospective research is necessary to guide clinical decision-making regarding HMB management.

Introduction and hypothesis The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP. Methods We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months. Results Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62–91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43–97%). The poorest results are described for the sacrospinal fixation (SSF; 35–81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5–9%). The highest percentage of complications were reported after ASC (2–19%), VM (6–29%), and RSC (54%). Mesh exposure was seen most often after VM (8–21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13–22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC. Conclusions A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review. Electronic supplementary material The online version of this article (10.1007/s00192-017-3493-2) contains supplementary material, which is available to authorized users

The purpose of this study was to compare the effectiveness of 8 versus 16 min of heating in the treatment of menorrhagia with hot fluid balloon ablation. Between 1995 and 1998, women with ...