Objective To investigate patient preferences for endometrial ablation and a le vonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectom y in the treatment of dysfunctional uterine bleeding. Design Comparative study b ased on structured interviews. Setting A large teaching hospital with 500 beds i n the Netherlands. Patient(s) Ninety-six patients who were scheduled for endome trial ablation, 25 patients who were scheduled for hysterectomy, and 23 patients who were scheduled for a levonorgestrel-releasing IUD were interviewed. All of the women had dysfunctional uterine bleeding. Intervention( s) Patients were as ked to state their most significant complaints and their reasons for choosing a particular treatment. Subsequently, the preference for endometrial ablation and a levonorgestrel-releasing IUD as alternatives to hysterectomy was assessed dur ing a structured interview. Women were informed about the advantages and disadva ntages of all three treatment options. Patients rated their preferences accordin g to different hypothetical success rates. The success rates after endometrial a blation and levonorgestrel-releasing IUD were varied until patients found an ac ceptable treatment outcome. Main outcome measure(s) Patient preference of endome trial ablation and the levonorgestrel-releasing IUD over hysterectomy. Result(s ) The main reason for the treatment of choice differed between the three groups. Most of the patients in the hysterectomy group wanted a definite solution to th eir problems, whereas patients in the levonorgestrel-releasing IUD group and in the ablation group put greater emphasis on a minimally invasive intervention wi th or without a short hospital stay. In women undergoing ablation, 70%of the pa tients preferred this treatment and the levonorgestrel-releasing IUD to hystere ctomy in cases in which the success rate of noninvasive treatment was presumed t o be 50%. Inwomen having a levonorgestrel-releasing IUD inserted, 95%of the p atients preferred this approach over hysterectomy in cases in which the success rate of this device was presumed to be 50%, whereas 35%of patients preferred a blation over hysterectomy in cases in which the success rate of ablation was pre sumed to be 50%. In women undergoing hysterectomy, 30%would have opted for abl ation and 45%would have opted for a levonorgestrel-releasing IUD in cases in w hich success rates were 50%. Of patients who opted for hysterectomy, however, 6 0%stated that they would have preferred a noninvasive treatment if the success rate of this type of treatment were >80%. Conclusion(s) A majority of the patie nts who had dysfunctional uterine bleeding and who were scheduled for an endomet rial ablation or a levonorgestrel-releasing IUD were inclined to take a risk of 50%likelihood of treatment failure to avoid a hysterectomy. As a consequence, research of treatment for dysfunctional uterine bleeding should focus on this 5 0%success level. Objective To investigate patient preferences for endometrial ablation and a le vonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectom y in the treatment of dysfunctional uterine bleeding. Design Comparative study b ased on structured interviews. Setting A large teaching hospital with 500 beds in the Netherlands. Patient (s) Ninety-six patients who were scheduled for endometrial ablation, 25 patients who were scheduled for hysterectomy, and 23 patients who were scheduled for a levonorgestrel-releasing IUD were interviewed. All of the women had dysfunctional uterine bleeding Intervention (s) Patients were as ked to state their most significant complaints and their reasons for a particular treatment. were informed about the advantages and disadva ntages of all three treatment options. Patients rated their preferences accordin g to different hypothetical success rates. The success rates after endometrial a blation and levonorgestrel-releasing IUD were varied until patients found an ac ceptable treatment outcome. Main outcome measure (s) Patient preference of endometrial ablation and the levonorgestrel Mostly the patients in the hysterectomy group wanted a definite solution to th eir problems, but the patients in the levonorgestrel-releasing IUD group and in the ablation group put greater emphasis on a minimally invasive intervention wi th or without a short hospital stay. In women undergoing ablation, 70% of the pa tients preferred this treatment and the levonorgestrel-releasing IUD to hysterectomy in cases in which the success rate of noninvasive treatment was presumed to be 50%. Inwomen having a levonorgestrel-releasing IUD inserted, 95% of the p atients preferred this approach over hysterectomy in cases in which the success rate of this device was presumed to be 50%, whereas 35% of patients preferred a blation over hysterectomy in cases in which the success rate of ablation was presumed to be 50 %. In women undergoing hysterectomy, 30% would have opted for abltion and 45% would have opted for a levonorgestrel-releasing IUD in cases in w hich success rates were 50%. Of patients who opted for hysterectomy, however, 60% stated that they would have preferred a noninvasive treatment if the success rate of this type of treatment were> 80%. Conclusion (s) A majority of the patients who had dysfunctional uterine bleeding and who were scheduled for an endomet rial ablation or a levonorgestrel -releasing IUD were inclined to take a risk of 50% likelihood of treatment failure to avoid a hysterectomy. As a consequence, research of treatment for dysfunctional uterine bleeding should focus on this 5 0% success level.