Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial.

Abstract

OBJECTIVE:

Menorrhagia is a common problem impairing the quality of life (QOL) of many women. Both levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy are effective treatment modalities but no long-term comparative studies of QOL and costs exist. The objective of this study was to compare QOL and costs of LNG-IUS or hysterectomy in the treatment of menorrhagia during 10-year follow-up.

STUDY DESIGN:

A total of 236 women, aged 35-49 years, referred for menorrhagia to 5 university hospitals in Finland were randomly assigned to treatment with LNG-IUS (n = 119) or hysterectomy (n = 117) and were monitored for 10 years. The main outcome measures were health-related QOL (HRQOL), psychosocial well-being, and cost-effectiveness.

RESULTS:

A total of 221 (94%) women were followed for 10 years. Although 55 (46%) women assigned to the LNG-IUS subsequently underwent hysterectomy, the overall costs in the LNG-IUS group ($3423) were substantially lower than in the hysterectomy group ($4937). Overall, levels of HRQOL and psychosocial well-being improved during first 5 years but diminished between 5 years and 10 years and the improved HRQOL returned close to the baseline level. There were no significant differences between LNG-IUS and hysterectomy groups.

CONCLUSION:

Both LNG-IUS and hysterectomy improved HRQOL. The improvement was most striking during the first 5 years. Although many women eventually had hysterectomy, LNG-IUS remained cost-effective.

• Authors: Satu Heliövaara-Peippo, Ritva Hurskainen, Juha Teperi, Anna-Mari Aalto, Seija Grénman, Karoliina Halmesmäki, Markus Jokela, Aarre Kivelä, Eija Tomás, Marjo Tuppurainen, Jorma Paavonen
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 209 Issue 6 Pg. 535.e1-535.e14 (Dec 2013) ISSN: 1097-6868 [Electronic] United States
• PMID: 23999423 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Mosby, Inc. All rights reserved.

Chemical References

• Levonorgestrel

Topics

• Adult
• Anxiety (diagnosis)
• Cost-Benefit Analysis
• Depression (diagnosis)
• Female
• Follow-Up Studies
• Health Care Costs (statistics & numerical data)
• Humans
• Hysterectomy
• Levonorgestrel (administration & dosage, therapeutic use)
• Menorrhagia (drug therapy, psychology, surgery)
• Middle Aged
• Quality of Life
• Statistics, Nonparametric
• Surveys and Questionnaires
• Treatment Outcome