The effect of hysterectomy or levonorgestrel-releasing intrauterine system on lower abdominal pain and back pain among women treated for menorrhagia: a five-year randomized controlled trial.
OBJECTIVE
The purpose of this study was to evaluate the changes in lower abdominal pain and back pain among women with menorrhagia treated by hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS).


METHODS
A randomized controlled trial.


METHODS
Five university hospitals in Finland.


METHODS
A total of 236 women, aged 35-49 years.


METHODS
Women were randomly assigned to treatment by hysterectomy (n = 117) or LNG-IUS (n = 119).


METHODS
Frequency and intensity of lower abdominal pain and back pain were evaluated by questionnaires at baseline and after 6 months, 12 months and 5 years.


RESULTS
By six months, women in both groups had less frequent back pain than before treatment (p < 0.001). Lower abdominal pain decreased only in the hysterectomy group (p = 0.02) with significant differences between the groups. Between 12 months and 5 years, frequency of lower abdominal pain (p = 0.05) and back pain (p = 0.002) decreased more in the LNG-IUS group than in the hysterectomy group. Between baseline and five years, the lower abdominal pain score (including frequency and intensity of pain) decreased in both groups (p < 0.001, p = 0.01). Back pain score decreased only in the LNG-IUS group and the difference between the groups was significant (p = 0.02). However, some women experienced more pain after both treatments than before treatment. In multivariate analyses, LNG-IUS use was associated with a decrease in lower abdominal pain and back pain.


CONCLUSIONS
In the treatment of menorrhagia, both hysterectomy and LNG-IUS decrease lower abdominal pain. LNG-IUS use, but not hysterectomy, has beneficial effects on back pain.
Heliövaara-Peippo
Satu
S
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. satu.heliovaara-peippo@helsinki.fi
Halmesmäki
Karoliina
K
Hurskainen
Ritva
R
Teperi
Juha
J
Grenman
Seija
S
Kivelä
Aarre
A
Kujansuu
Erkki
E
Tuppurainen
Marjo
M
Vuorma
Sirkku
S
Yliskoski
Merja
M
Paavonen
Jorma
J
D015746:Abdominal Pain / Q000209:etiology* / Q000628:therapy; D000328:Adult; D001416:Back Pain / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008595:Menorrhagia / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D008875:Middle Aged; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D016912:Levonorgestrel