Early ReportQuality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial
Introduction
Excessive menstrual blood loss accounts for more than 10% of outpatient referrals to gynaecology consultants, and about half of the referred women will undergo hysterectomy within 5 years.1 Although hysterectomy is by definition more effective than other treatment modalities for menorrhagia, the associated morbidity and complication rates cannot be ignored.2, 3 The levonorgestrel-releasing intrauterine system (IUS) effectively reduces menstrual blood loss.4, 5 Crosignani and colleagues' randomised trial showed no significant differences in the quality of life between groups treated with the levonorgestrel-releasing IUS or by endometrial resection after 1 year of follow-up, as measured by the short form 36.6 However, the effectiveness of the levonorgestrel-releasing IUS has not been systematically compared with that of hysterectomy.
We undertook a randomised trial of the levonorgestrel-releasing IUS or hysterectomy in the treatment of menorrhagia. The outcome measures were health-related quality of life, other measures of psychological wellbeing (anxiety, depression, sexual function), and costs. We report the results after the first year of follow-up.
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Participants
The women who took part in the study were referred by general practitioners or gynaecologists to one of the five university hospitals in Finland because of menorrhagia, between November, 1994, and November, 1997. Women who had no indication of predefined exclusion criteria when referred were assessed by medical history, physical examination, cervical smear, transvaginal ultrasonography, and endometrial biopsy. When clinically indicated, hysteroscopy was also done. The predefined exclusion
Study population
598 women were screened (figure 1). The 362 women ineligible or unwilling to take part did not differ from the study group in terms of age, employment status, or occupation. Of the 236 participants, 107 were enrolled in Helsinki, 44 in Kuopio, 22 in Oulu, 21 in Tampere, and 42 in Turku. Baseline characteristics of the participants are given in table 1.
Levonorgestrel-IUS group
Of the 119 women assigned to the levonorgestrel-releasing IUS group (figure 1), 117 attended the 6-month follow-up visit and 116 the 12-month
Discussion
Hysterectomy was successful in the treatment of menorrhagia in this study, but it was associated with several complications. The levonorgestrel-releasing IUS was also successful in decreasing menstrual blood loss in most women. However, about a third of devices were removed, and 20% of the women underwent hysterectomy during the first year of follow-up. Health-related quality of life and other measures of psychosocial wellbeing improved in both groups. At 12 months, there were no significant
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Cited by (273)
Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynecologists and Obstetricians (CNGOF)
2022, Gynecologie Obstetrique Fertilite et SenologieComparison of Levonorgestrel-releasing Intrauterine System (LNG-IUS) against Laparoscopic Assisted Supracervical Hysterectomy (LASH) for menorrhagia treatment: An economic evaluation
2021, Journal of Gynecology Obstetrics and Human ReproductionAssociation of levonorgestrel intrauterine devices with stress reactivity, mental health, quality of life and sexual functioning: A systematic review
2021, Frontiers in NeuroendocrinologyCitation Excerpt :Satisfaction rate with LNG-IUD was very high (98%) and so was the continuation rate (90%). A 10-year longitudinal study compared LNG-IUD treatment to hysterectomy for menorrhagia and reported an improved quality of life and well-being during the first year (Hurskainen et al., 2001) and at five-years follow-up (Heliovaara-Peippo et al., 2013) in both groups, with no significant group differences. At 10-years follow-up, the quality of life declined, returning to baseline levels in both groups.
Treatment of women with heavy menstrual bleeding: Results of a prospective cohort study alongside a randomised controlled trial
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyEvaluating the Prevalence of Regret With the Decision to Proceed With a Hysterectomy in Women Younger than Age 35
2020, Journal of Obstetrics and Gynaecology CanadaA survey of young women's perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire
2019, Sexual and Reproductive HealthcareCitation Excerpt :Studies evaluating the Lng-IUS have yielded contradictory findings. Some studies indicate negative changes of certain aspects of sexual function [20–23], whereas others report no changes [24] or even increased sexual health quality [11,25–27]. In a qualitative study [28], use of hormone-free contraceptive alternatives was pointed out as one of six important themes for women using the Cu-IUD.