Human Reproduction, Vol. 19, No. 2, 378-382,
February 2004
© 2004 European Society of Human Reproduction and Embryology
A randomized controlled trial of hysterectomy or levonorgestrel-releasing intrauterine system in the treatment of menorrhagia—effect on FSH levels and menopausal symptoms
1 Department of Obstetrics and Gynecology, Central Hospital of Päijät-Häme, Keskussairaalankatu 7, 15850 Lahti, 2 Department of Obstetrics and Gynecology, University of Helsinki and Health Services Research Unit, Stakes, Lintulahdenkuja 4, PL 220, 00531 Helsinki, 3 Department of Obstetrics and Gynecology, University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, 4 Health Services Research Unit, Stakes, Lintulahdenkuja 4, PL 220, 00531 Helsinki, 5 Department of Obstetrics and Gynecology, University of Turku, Kiinanmyllynkatu 4–8, 20520 Turku, 6 Department of Obstetrics and Gynecology, University of Oulu, Oulun yliopistollinen keskussairaala, PL22, 90221 Oulu, 7 Department of Obstetrics and Gynecology, University of Tampere, Tampereen yliopistollinen keskussairaala, PL 2000, 33521 Tampere and 8 Department of Obstetrics and Gynecology, University of Kuopio, Kuopion yliopistollinen sairaala, PL 1777, 70211 Kuopio, Finland
9 To whom correspondence should be addressed. e-mail: halmesma{at}mappi.helsinki.fi
BACKGROUND: The purpose of this study was to compare the effects of hysterectomy and a levonorgestrel-releasing intrauterine system (LNG-IUS) on serum FSH levels and menopausal symptoms. METHODS: A total of 236 women referred for menorrhagia to five university hospitals were randomly assigned to treatment with hysterectomy (n = 117) or LNG-IUS (n = 119). Menopausal symptoms were characterized by the Kupperman menopausal distress test. Serum FSH and estradiol levels were measured at baseline and 6 and 12 months after hysterectomy or application of LNG-IUS. Analyses were by intention to treat. RESULTS: After 6 months, there was no difference between the groups, but 12 months after follow-up hysterectomized women had higher FSH levels than women with LNG-IUS (P = 0.005). There was a significant association between FSH levels and treatment modality (P = 0.020). Hot flushes increased significantly in the hysterectomy group (P = 0.02). There was a significant association between hot flushes and both treatment modality and age (P = 0.02 and P = 0.01, respectively). CONCLUSION: Hysterectomy may impair ovarian function shown by rising serum FSH levels and hot flushes. However, these results should be interpreted with caution, and longer follow-up is needed.
Key words: FSH/hot flushes/hysterectomy/levonorgestrel-releasing intrauterine system/menopausal symptoms
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