title: 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.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. satu.heliovaara-peippo@helsinki.fi
authors.forename: Satu
authors.initials: S
authors.lastname: Heliövaara-Peippo
authors.forename: Karoliina
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: Ritva
authors.initials: R
authors.lastname: Hurskainen
authors.forename: Juha
authors.initials: J
authors.lastname: Teperi
authors.forename: Seija
authors.initials: S
authors.lastname: Grenman
authors.forename: Aarre
authors.initials: A
authors.lastname: Kivelä
authors.forename: Erkki
authors.initials: E
authors.lastname: Kujansuu
authors.forename: Marjo
authors.initials: M
authors.lastname: Tuppurainen
authors.forename: Sirkku
authors.initials: S
authors.lastname: Vuorma
authors.forename: Merja
authors.initials: M
authors.lastname: Yliskoski
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
mesh_terms: 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
chemical_list: D016912:Levonorgestrel