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.
Acknowledgements
Teija Karkkulainen and research nurses from Kuopio, Tampere, Turku and Oulu University hospitals are thanked for their assistance in data collection. The study was funded by Academy of Finland 2004.
Disclosure of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.