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

Satu Heliövaara‐Peippo, Karoliina Halmesmäki, Ritva Hurskainen, Juha Teperi, Seija Grénman, Aarre Kivelä, Erkki Kujansuu, Marjo Tuppurainen, Sirkku Vuorma, Merja Yliskoski, Jorma Paavonen
In: Acta Obstetricia et Gynecologica Scandinavica · 2009 · vol. 88(12) , pp. 1389–1396 · doi:10.3109/00016340903297150 · PMID:19878089 · W2055152822
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This randomized controlled trial found that hysterectomy and levonorgestrel-releasing intrauterine systems both reduced lower abdominal pain in women with menorrhagia, but only the levonorgestrel-releasing intrauterine system improved back pain.

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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). DESIGN: A randomized controlled trial. SETTING: Five university hospitals in Finland. SAMPLE: 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). MAIN OUTCOME MEASURES: 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.

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