Miguel Bronchud, Veteran Cancer Clinician and Researcher and Co-Founder of Regenerative Medicine Solutions, shared on LinkedIn:
“Preserving the uterus in non malignant excessive bleeding : an effective dual therapy to avoid hysterectomy?
Heavy menstrual bleeding is a challenging condition that, when refractory to conventional treatment, frequently culminates in hysterectomy. Of course the first objective (especially in patients with risk factors) is to rule out underlying endometrial cancer.
Endometrial ablation offers an effective, uterus-sparing alternative for women who do not desire future childbearing, with lower perioperative morbidity and faster recovery than hysterectomy.
But the durability of this procedure can be variable. Residual endometrium can result in recurrent bleeding or cyclical pelvic pain requiring further treatment, with approximately one in ten women undergoing hysterectomy within 2 years.
See from National Institute for Health and Care Excellence: Heavy menstrual bleeding: assessment and management.
The combination of endometrial ablation and LNG-IUS significantly reduced the incidence of hysterectomy compared with endometrial ablation alone. The combined treatment appears to be a safe adjunctive strategy for heavy menstrual bleeding that does not increase the risk of complications.
(Funding from The Netherlands Organization for Health Research and Development.)
Endometrial ablation plus levonorgestrel-releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding in The Netherlands (MIRA2): a multicentre, open-label, randomised, controlled, superiority trial
Lancet. 2026, published online Oct 21.
Endometrial ablation is an established and effective treatment for women with heavy menstrual bleeding, but many patients require further treatment, with approximately 10% ultimately undergoing a hysterectomy within 2 years.
The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) immediately after endometrial ablation might inactivate residual untreated endometrium or prevent its regeneration, thereby preventing recurrent symptoms necessitating a hysterectomy.
The aim of this Dutch study was to assess whether LNG-IUS insertion immediately after endometrial ablation in women with heavy menstrual bleeding reduced the need for subsequent hysterectomy within 2 years compared with endometrial ablation alone.
In participants allocated to combined treatment, intrauterine insertion of an LNG-IUS containing a total of 52 mg of levonorgestrel (releasing 20 μg per day in the first year) was done immediately after the ablative procedure.
The primary outcome was the incidence of hysterectomy within 2 years, analysed on a modified intention-to-treat basis in all participants with available data. Serious adverse events were systematically assessed.”
Title: Endometrial ablation plus levonorgestrel-releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding in The Netherlands (MIRA2): a multicentre, open-label, randomised, controlled, superiority trial
Authors: Tamara J Oderkerk, Jaklien C Leemans, Pleun Beelen, Malou C Herman, Sjors F P J Coppus, Marijke C van der Weide, Sander M J Van Kuijk, Thomas J Clark, Marlies Y Bongers, Peggy M A J Geomini.
Other articles from Miguel Bronchud on OncoDaily.