title: Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial.
abstract: OBJECTIVE
  Menorrhagia is a common problem impairing the quality of life (QOL) of many women. Both levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy are effective treatment modalities but no long-term comparative studies of QOL and costs exist. The objective of this study was to compare QOL and costs of LNG-IUS or hysterectomy in the treatment of menorrhagia during 10-year follow-up.
  
  
  METHODS
  A total of 236 women, aged 35-49 years, referred for menorrhagia to 5 university hospitals in Finland were randomly assigned to treatment with LNG-IUS (n = 119) or hysterectomy (n = 117) and were monitored for 10 years. The main outcome measures were health-related QOL (HRQOL), psychosocial well-being, and cost-effectiveness.
  
  
  RESULTS
  A total of 221 (94%) women were followed for 10 years. Although 55 (46%) women assigned to the LNG-IUS subsequently underwent hysterectomy, the overall costs in the LNG-IUS group ($3423) were substantially lower than in the hysterectomy group ($4937). Overall, levels of HRQOL and psychosocial well-being improved during first 5 years but diminished between 5 years and 10 years and the improved HRQOL returned close to the baseline level. There were no significant differences between LNG-IUS and hysterectomy groups.
  
  
  CONCLUSIONS
  Both LNG-IUS and hysterectomy improved HRQOL. The improvement was most striking during the first 5 years. Although many women eventually had hysterectomy, LNG-IUS remained cost-effective.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: satu.heliovaara-peippo@hus.fi.
authors.forename: Satu
authors.initials: S
authors.lastname: Heliövaara-Peippo
authors.forename: Ritva
authors.initials: R
authors.lastname: Hurskainen
authors.forename: Juha
authors.initials: J
authors.lastname: Teperi
authors.forename: Anna-Mari
authors.initials: AM
authors.lastname: Aalto
authors.forename: Seija
authors.initials: S
authors.lastname: Grénman
authors.forename: Karoliina
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.forename: Aarre
authors.initials: A
authors.lastname: Kivelä
authors.forename: Eija
authors.initials: E
authors.lastname: Tomás
authors.forename: Marjo
authors.initials: M
authors.lastname: Tuppurainen
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D003863:Depression / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy; D016912:Levonorgestrel / Q000008:administration & dosage / Q000627:therapeutic use*; D008595:Menorrhagia / Q000188:drug therapy* / Q000523:psychology / Q000601:surgery; D008875:Middle Aged; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D016912:Levonorgestrel
keywords: cost-effectiveness; health-related quality of life; hysterectomy; levonorgestrel-releasing intrauterine system; menorrhagia