Hysterectomy versus GnRH agonist for dysfunctional uterine bleeding in premenopausal women

Dysfunctional uterine bleeding (DUB) in premenopausal women is a common problem leading to medical or surgical intervention. The aim of this study was to compare GnRH agonist and hysterectomy in treatment of DUB in premenopausal women. In a randomized clinical trial, 250 patients of age, 40 to 55 years with complaint of abnormal uterine bleeding resistant to routine medications were enrolled into the study. Ninety seven patients after ruling out organic, was randomized to receive either hysterectomy or 4 doses of diphereline. Two groups followed up 6 and 24 months after intervention. From 97 patients, 85 accomplished the study. Bleeding stopped in 91.8% of patients after 2nd dose of diphereline, which is beyond 6 and 24 months, 73.33 and 40.9% had amenorrhea, respectively. There were no significant differences between two groups in pelvic pain, mastalgia, sleep disorders, sexual function, stress incontinence and urgency after 2 years follow up. Low back pain, urinary frequency and depression were significantly higher in patients that underwent hysterectomy (P = 0.03, P = 0.03 and P < 0.001, respectively). There was more satisfaction of treatment (67.5% versus 44.4%, P = 0.004) and better quality of life after 2 years (34.1% versus 16.7%, P = 0.08) in diphereline group. GnRH agonist is an appropriate alternative to hysterectomy for treatment of DUB in premenopausal women.