Abnormal uterine bleeding or AUB is a common condition that significantly affects women’s quality of life and is classified using the FIGO PALM COEIN system. Although hysterectomy has traditionally been the definitive treatment, it carries surgical and psychological risks. The levonorgestrel-releasing intrauterine system has emerged as an effective, conservative alternative that reduces menstrual blood loss, improves haemoglobin levels, and enhances quality of life. Multiple studies have shown high satisfaction rates and significant symptom improvement with LNG-IUS. Comparative research indicates that while hysterectomy offers higher satisfaction for some women, LNG-IUS is associated with fewer complications and is cost-effective. Indian studies similarly demonstrate the strong efficacy and acceptability of LNG-IUS. Despite growing evidence supporting both treatments, no standardised guideline exists to guide choice between LNG-IUS and hysterectomy, highlighting the need for further comparative studies to inform clinical decision-making and improve patient counselling.