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, Satu Heliövaara-Peippo, Karoliina Halmesmäki, Ritva Hurskainen, Juha Teperi, Seija Grenman, Seija Grénman, Aarre Kivelä, Erkki Kujansuu, Marjo Tuppurainen, Sirkku Vuorma, Merja Yliskoski, Jorma Paavonen
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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MeSH descriptors

Abdominal Pain Back Pain Hysterectomy Intrauterine Devices, Medicated Levonorgestrel Menorrhagia Menorrhagia Abdominal Pain Abdominal Pain Adult Back Pain Back Pain Female Humans Levonorgestrel Menorrhagia Menorrhagia Middle Aged Statistics, Nonparametric Surveys and Questionnaires

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