title: Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis.
abstract: OBJECTIVE
  To compare the levonorgestrel intrauterine system (LNG-IUS) with hysterectomy in patients with adenomyosis and to study the effects of both treatments on quality of life (QOL).
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  Women's health teaching and research hospital.
  
  
  METHODS
  Eighty-six patients (43 patients for each group) were enrolled, but only 75 women continued the study.
  
  
  METHODS
  Women interpreted as having adenomyosis on transvaginal ultrasound and magnetic resonance imaging were assigned to receive either LNG-IUS or hysterectomy.
  
  
  METHODS
  Clinical measures of menstrual bleeding as number of used pads/day during menstruation, hemoglobin levels, and health-related QOL variables were assessed. Each woman was followed up for 1 year after treatment.
  
  
  RESULTS
  LNG-IUS increased the hemoglobin levels at the sixth month and first year of the treatment to the comparable levels with hysterectomy. When pretreatment and post-treatment QOL scores of groups were compared, three of the five mean domain scores (physical, environmental, environmental-TR) were increased in patients treated with hysterectomy, while in patients managed with LNG-IUS, all five mean domain scores were increased.
  
  
  CONCLUSIONS
  It seems that LNG-IUS demonstrates significant and comparable improvements in hemoglobin levels to hysterectomy in treating adenomyosis-associated menorrhagia during the first year. Although both treatments lead to improvements in health-related QOL, LNG-IUS seems to have superior effects on psychological and social life. It may be a promising alternative therapy to hysterectomy.
authors.affiliation: Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecology Clinic, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ozdegirmenci
authors.forename: Fulya
authors.initials: F
authors.lastname: Kayikcioglu
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Akgul
authors.forename: Metin
authors.initials: M
authors.lastname: Kaplan
authors.forename: Musturay
authors.initials: M
authors.lastname: Karcaaltincaba
authors.forename: Ali
authors.initials: A
authors.lastname: Haberal
authors.forename: Mesut
authors.initials: M
authors.lastname: Akyol
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008595:Menorrhagia / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D005300:Fertility Agents, Female; D016912:Levonorgestrel