Clinical recommendation	Evidence rating	References	Comments
Physicians should prescribe oral progestin therapy for 21 continuous days (days 5 to 26 of the menstrual cycle) to reduce menstrual blood loss.	A	26	21-day continuous progestin therapy is the most effective short-term medical treatment of menorrhagia, but patient satisfaction is higher with the levonorgestrel-releasing intrauterine device.
The levonorgestrel-releasing intrauterine device is an effective long-term option for menorrhagia if future childbearing is desired.	A	31	—
Physicians should prescribe hysterectomy for patients in whom no further childbearing is desired.	A	37	This is for patients who are willing to assume the risk of major surgery.
For patients who wish to avoid major surgery and in whom childbearing is completed, endometrial ablation is a reasonable and effective alternative to hysterectomy.	A	37	—