In clinical practice, the paradigm of evidence-based medicine currently holds sway. Evidence-based medicine implies not only the application of effective treatments but also their rational use within a comprehensive management framework. One of the paradoxes in the modern surgical management of excessive menstrual blood loss is that it was not until the surgical alternatives to hysterectomy were being evaluated, that a proper critical reappraisal for our existing methods of treatment (both medical and surgical) occurred. Evidence is now classified ( Tables 26.1 and 26.2 ), based on the scientific robustness of the source. A well-conducted randomized controlled trial (RCT) – or preferably a few, thereby increasing the generalizability – is the pinnacle of the evidence pyramid.