Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB)

Inclusion Criteria: * Abnormal uterine bleeding in the absence of structural pathology, pharmacologic agents, IUD use, or systemic disorders of hemostasis that could explain the condition. Exclusion Criteria: Prescreen * Age \< 18 years * Postmenopausal status (or bilateral oophorectomy) * Bleeding not considered excessive by woman * Desire to retain fertility * Refusal to consider surgery * Known myoma (from prior examination) Eligibility Screen * Lack of willingness to have a gynecologic or ultrasound examination * Lack of willingness to be interviewed about bleeding or consider study * Pregnancy * Prior endometrial resection or ablation * Prior myomectomy, myolysis, or hysterectomy Medical History * No tentative diagnosis of DUB * History of malignancy of vagina, cervix, endometrium, or ovary * History of complex endometrial hyperplasia or simple hyperplasia with atypia * Current use of tamoxifen * \< 6 months since onset of excessive uterine bleeding * \< 9 months since stopping the use of IUD * \< 9 months since stopping the use of implantable hormone agent * \< 18 months since stopping use of Depo-Provera * \< 6 months of anovulatory DUB after reaching euthyroid status for woman with diagnosis of hypothyroidism * \< 3 months since pathology results indicate presence of endometrial polyp Baseline Gynecologic Examination * Enlarged (\>= 14 weeks gestational age) uterus * Focal bleeding of genital, urinary, or gastrointestinal tract Ultrasound Examination * Presence of any submucosal myoma * Presence of any myoma \>= 3 cm, any location * Presence of \> 3 myomas, any size or location * Presence of endometrial polyp(s) * Malignancy of the vagina, cervix, endometrium, or ovary Laboratory and Ancillary Tests * FSH level in women ages \> 45 years confirming postmenopausal status * Abnormal urinary tract or gastrointestinal tract imaging related to uterine bleeding * Evidence of cervical cancer (screened by Pap smear in last 12 months and confirmed by colposcopy) * Evidence of complex endometrial hyperplasia or simple hyperplasia with atypia or endometrial cancer (endometrial biopsy in last 12 months) * Any test value inconsistent with a diagnosis of DUB * Any test values, unlikely to change, compromising patient safety for surgery Other * Any existing medical condition, unlikely to change, putting patient at excessive risk for surgery * Request for prophylactic bilateral oophorectomy by woman aged \<45 years * Lack of willingness to comply with study requirements * Uncooperative behavior * Any coexisting condition that may influence a patient's ability to comply with participation * Refusal to allow evaluation or follow-up * In process of scheduling surgery at time of baseline visit Provisional Eligibility Criteria * Refusal of randomization * \< 3 months of medical management (excluding GnRH agonist therapy) within the past 2 years * Ongoing evaluation or treatment for abnormal cervical cytology (including endocervical polyps) * Gastrointestinal or urinary tract condition unrelated to uterine bleeding currently being treated * Any temporary test value compromising patient safety * Any temporary existing medical condition putting patient at excessive risk from surgery * Any coexisting condition requiring surgery (except tubal occlusion for any woman or oophorectomy for women \>= 45 years of age) * Lack of willingness to proceed with surgery at this time * Lack of willingness to proceed with surgery likely to result in infertility