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A randomized controlled trial of hysterectomy or levonorgestrel-releasing intrauterine system in the treatment of menorrhagia-effect on FSH levels and menopausal symptoms.

Author(s): Halmesmaki K, Hurskainen R, Tiitinen A, Teperi J, Grenman S, Kivela A, Kujansuu E, Yliskoski M, Paavonen J

Affiliation(s): Department of Obstetrics and Gynecology, Central Hospital of Paijat-Hame, Keskussairaalankatu 7, 15850 Lahti, Finland. halmesma@mappi.helsinki.fi

Publication date & source: 2004-02, Hum Reprod., 19(2):378-82.

Publication type: Clinical Trial; Randomized Controlled Trial

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.

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