Because menorrhagia is often a reason for seeking medical attention,
it is important to consider outcomes and costs associated with alternative
treatment modalities. Both the levonorgestrel-releasing intrauterine system
(LNG-IUS) and hysterectomy have proven effective for treatment of menorrhagia
but there are no long-term comparative studies measuring cost and quality
To compare outcomes, quality-of-life issues, and costs of the LNG-IUS
vs hysterectomy in the treatment of menorrhagia.
Design, Setting, and Participants
Randomized controlled trial conducted between October 1, 1994, and October
6, 2002, and enrolling 236 women (mean [SD] age, 43 [3.4] years) referred
to 5 university hospitals in Finland for complaints of menorrhagia.
Participants were randomly assigned to treatment with the LNG-IUS (n
= 119) or hysterectomy (n = 117) and were monitored for 5 years.
Main Outcome Measures
Health-related quality of life (HRQL) as measured by the 5-Dimensional
EuroQol and the RAND 36-Item Short-Form Health Survey, other measures of psychosocial
well-being (anxiety, depression, and sexual function), and costs.
After 5 years of follow-up, 232 women (99%) were analyzed for the primary
outcomes. The 2 groups did not differ substantially in terms of HRQL or psychosocial
well-being. Although 50 (42%) of the women assigned to the LNG-IUS group eventually
underwent hysterectomy, the discounted direct and indirect costs in the LNG-IUS
group ($2817 [95% confidence interval, $2222-$3530] per participant) remained
substantially lower than in the hysterectomy group ($4660 [95% confidence
interval, $4014-$5180]). Satisfaction with treatment was similar in both groups.
By providing improvement in HRQL at relatively low cost, the LNG-IUS
may offer a wider availability of choices for the patient and may decrease
costs due to interventions involving surgery.