Fitting a hormonal IUD during endometrial ablation more than halved later hysterectomies, Lancet trial finds

A randomised trial published in The Lancet on 22 October 2026 suggests that inserting a levonorgestrel-releasing intrauterine system (hormonal IUD, such as Mirena) at the end of an endometrial ablation reduces the chance that women with heavy periods later need a hysterectomy.

The study

• MIRA2 enrolled 715 women with heavy menstrual bleeding at 34 hospitals in the Netherlands and followed them for two years.
• Half had a hormonal IUD fitted immediately after their ablation; the other half had ablation alone.
• After two years, about 4% of women in the IUD group had needed a hysterectomy, compared with 10% in the ablation-only group.

Other findings

• At six months, more women in the IUD group had no periods at all (59% vs 46%).
• Fewer needed extra medication to control bleeding over two years (6% vs 16%).
• At two years, fewer reported cyclical period pain (17% vs 25%).

Heavy menstrual bleeding affects about 30% of women of reproductive age in European countries, according to the release, and roughly one in ten women still needs a hysterectomy within two years of an ablation.

Limitations

The trial was open-label — women and doctors knew which treatment was given — which can influence reported symptoms and decisions about further surgery. It was carried out in one country and followed patients for two years only. The authors note that IUD side effects were commonly reported and could lead women to have the device removed, so this should be part of counselling. Anyone considering these procedures should talk to their gynaecologist.