title: Resources and procedures in the treatment of heavy menstrual bleeding with the levonorgestrel-releasing intrauterine system (LNG-IUS) or hysterectomy in Brazil.
abstract: BACKGROUND
  Heavy menstrual bleeding (HMB) is the most common complaint of women seeking gynecological care. Treatments included surgical or medical options including hysterectomy and the levonorgestrel-releasing intrauterine system (LNG-IUS) due to the profound suppression of endometrial growth that intrauterine LNG exerts which results in amenorrhea or in a reduction of blood loss.
  
  
  OBJECTIVE
  The study was conducted to evaluate the resources and procedures involved in inserting an LNG-IUS compared to performing hysterectomy in women with HMB in a public sector hospital in Brazil.
  
  
  METHODS
  Two cohorts of women were studied: women who accepted an LNG-IUS (n=124) and matched women who underwent hysterectomy on the same day (n=122). We evaluate the number of procedures carried out in each group of women, including those performed before the decision was made to insert an LNG-IUS or to perform hysterectomy, the insertion of the device itself and the surgical procedure, in addition to the procedures and complications registered up to 1 year after LNG-IUS insertion or hysterectomy.
  
  
  RESULTS
  Age and the duration of HMB were significantly lower in the LNG-IUS acceptors than women at the hysterectomy group. The numbers of gynecological consultations and Pap smears were similar in both groups; however, women in the hysterectomy group also underwent laboratory tests, ultrasonography, chest X-ray and electrocardiogram. In the hysterectomy group, the main complications were hemorrhage (six), bladder/bowel perforation (four), complications with anesthesia (one), ureteral reimplantation required (one) and abdominal pain (two). At 1 year, HMB was controlled in 83.1% of women in the LNG-IUS group, and 106 women continued with the device.
  
  
  CONCLUSIONS
  Both treatments were effective in HMB control. Fewer resources and complications were observed in LNG-IUS acceptors when compared to hysterectomy. The LNG-IUS represents a good strategy for reducing the number of hysterectomies and the resources required for women with HMB.
authors.affiliation: Department of Obstetrics and Gynecology, Human Reproduction Unit, School of Medical Sciences, University of Campinas, (UNICAMP) and National Institute of Hormones and Women's Health, 13084-971 Campinas, SP, Brazil. vbahamondes@cemicamp.org.br
authors.forename: M Valeria
authors.initials: MV
authors.lastname: Bahamondes
authors.forename: Yuri
authors.initials: Y
authors.lastname: de Lima
authors.forename: Vanessa
authors.initials: V
authors.lastname: Teich
authors.forename: Luis
authors.initials: L
authors.lastname: Bahamondes
authors.forename: Ilza
authors.initials: I
authors.lastname: Monteiro
mesh_terms: D000328:Adult; D001938:Brazil; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data*; D007433:Intrauterine Device Expulsion; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000191:economics / Q000627:therapeutic use*; D008595:Menorrhagia / Q000628:therapy*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel