title: The effect of hysterectomy or levonorgestrel-releasing intrauterine system on premenstrual symptoms in women treated for menorrhagia: secondary analysis of a randomized controlled trial.
abstract: OBJECTIVE
  To study the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on premenstrual symptoms in women treated for menorrhagia.
  
  
  METHODS
  Secondary analysis of a randomized controlled trial.
  
  
  METHODS
  Five university hospitals in Finland.
  
  
  METHODS
  A cohort of 236 women, aged 35-49 years (mean 43 years) referred for menorrhagia between 1994 and 1997. Women were not diagnosed with premenstrual syndrome.
  
  
  METHODS
  Women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Analyses were performed using the intention-to-treat and actual treatment principles. Women using estrogen therapy and women who underwent bilateral salpingo-oophorectomy were excluded from the analyses.
  
  
  METHODS
  The occurrence of premenstrual symptoms evaluated by questionnaires at baseline and at follow-up visits six and 12 months after the treatment and five years after the randomization.
  
  
  RESULTS
  Premenstrual symptoms decreased significantly in both groups by six months (p≤0.028) without significant differences between the groups, except that in the LNG-IUS group the decrease of breast tenderness was seen first by 12 months (p=0.048). Even though 42% of the women assigned to treatment with LNG-IUS were hysterectomized during the follow-up period, the results of intention-to-treat and actual treatment analyses were comparable.
  
  
  CONCLUSIONS
  Both hysterectomy and LNG-IUS seem to alleviate premenstrual symptoms of women treated for menorrhagia, while the effect of these treatments on premenstrual syndrome remains unsettled.
authors.affiliation: Department of Obstetrics and Gynecology, Hyvinkää Hospital, Finland. henri.leminen@hus.fi
authors.forename: Henri
authors.initials: H
authors.lastname: Leminen
authors.forename: Satu
authors.initials: S
authors.lastname: Heliövaara-Peippo
authors.forename: Karoliina
authors.initials: K
authors.lastname: Halmesmäki
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: Marjo
authors.initials: M
authors.lastname: Tuppurainen
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.forename: Ritva
authors.initials: R
authors.lastname: Hurskainen
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D016015:Logistic Models; D008595:Menorrhagia / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D011293:Premenstrual Syndrome / Q000150:complications / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel