The effect of hysterectomy or levonorgestrel-releasing intrauterine system on cardiovascular disease risk factors in menorrhagia patients: A 10-year follow-up of a randomised trial

Satu Heliövaara‐Peippo, R. Oksjoki, Karoliina Halmesmäki, Risto Kaaja, Juha Teperi, Seija Grénman, Aarre Kivelä, Heljä‐Marja Surcel, Eija Tomás, M. Tuppurainen, Ritva Hurskainen, Jorma Paavonen
In: Maturitas · 2011 · vol. 69(4) , pp. 354–358 · doi:10.1016/j.maturitas.2011.05.004 · PMID:21684096 · W2036176489
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This randomized trial followed menorrhagia patients for 10 years to compare cardiovascular disease risk factors after hysterectomy versus a levonorgestrel-releasing intrauterine system.

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Abstract

ObjectiveTo compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up.Study designA total of 236 women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality.Main outcome measuresWaist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed.ResultsAfter 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P=0.008 vs from 5.1% to 8.4%, P=0.08), as well as they had significantly higher serum levels of TNF-α (108.59 pg/ml vs 49.02 pg/ml, P=0.001) and hsCRP (1.55 μg/ml vs 0.78 μg/ml, P=0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids.ConclusionsHysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events.

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