Beelen P, Van Den Brink MJ, Herman MC, et al. - Researchers performed comparison of the effectiveness of the levonorgestrel intrauterine system vs endometrial ablation in women with heavy menstrual bleeding via conducting a multicenter randomized controlled non-inferiority trial in 26 hospitals and in a network of general practices in the Netherlands. Among 645 eligible women, 270 provided informed consent and were allocated to the levonorgestrel intrauterine system (n = 132; baseline Pictorial Blood Assessment Chart (PBAC)-score 616) or to endometrial ablation (n = 138; baseline PBAC-score 630).  Women with heavy menstrual bleeding had a large decrease in menstrual blood loss in correlation with both the levonorgestrel intrauterine system and endometrial ablation strategy, with comparable quality of life scores after treatment. Nevertheless, a significant difference was noted in menstrual blood loss which was in favor of endometrial ablation, and non-inferiority of starting with the levonorgestrel intrauterine system could not be established. An increased risk of needing additional treatment was reported for women who start with the levonorgestrel intrauterine system, a reversible and less invasive treatment, when compared with women who start with endometrial ablation. These results will aid in making a well-informed decision between the two treatments.