RESUMEN
OBJECTIVE: To compare among women with menorrhagia the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on sexual functioning. DESIGN: A randomised controlled trial. SETTING: Five university hospitals in Finland. SAMPLE: A total of 236 women, aged 35-49 years. METHODS: Of the women, 117 were treated by hysterectomy and 119 by LNG-IUS. MAIN OUTCOME MEASURES: Sexual functioning was evaluated by modified McCoy sexual scale at baseline and at 6 months, 12 months, and 5 years after initiation of treatment (hysterectomy or application of LNG-IUS). RESULTS: Among women treated by hysterectomy, sexual satisfaction increased and sexual problems decreased. Among LNG-IUS users, satisfaction with partner decreased. In addition to treatment modality (P = 0.02), estrogen therapy (P = 0.01), smoking (P = 0.001), night sweats (P = 0.03), vaginal dryness (P = 0.04), hot flushes (P = 0.01), and having someone to ask for advice (P = 0.03) and to share worries (P = 0.01) explained changes in sexual functioning. CONCLUSIONS: Among women with menorrhagia, hysterectomy improves sexual functioning, whereas LNG-IUS does not have such a positive effect.
Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Histerectomía/métodos , Dispositivos Intrauterinos Medicados , Levonorgestrel/administración & dosificación , Menorragia/terapia , Disfunciones Sexuales Fisiológicas/prevención & control , Adulto , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Satisfacción del Paciente , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia. DESIGN: Cross-sectional comparative study of women referred for menorrhagia. SETTING: Gynaecology departments of all five university teaching hospitals in Finland. SAMPLE: Two hundred and twenty-six women aged 35-49 years complaining of menorrhagia. MAIN OUTCOME MEASURES: Several psychosocial factors, seeking medical attention, menstrual blood loss. RESULTS: Twenty-nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss <60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained significant variables by multivariate analysis. CONCLUSIONS: A significant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia.
Asunto(s)
Menorragia/psicología , Aceptación de la Atención de Salud/psicología , Adulto , Ansiedad/etiología , Estudios Transversales , Depresión/etiología , Femenino , Humanos , Acontecimientos que Cambian la Vida , Modelos Logísticos , Persona de Mediana Edad , Conducta Sexual , Apoyo Social , Factores SocioeconómicosRESUMEN
BACKGROUND: Heavy menstrual blood loss is a common reason for women to seek medical care. The levonorgestrel-releasing intrauterine system (IUS) is an effective medical treatment for menorrhagia. We report a randomised comparison of this approach with hysterectomy in terms of the quality of life of women with menorrhagia and cost-effectiveness. METHODS: Of 598 women referred with menorrhagia to five university hospitals in Finland, 236 were eligible and agreed to take part. They were randomly assigned treatment with the levonorgestrel-releasing IUS (n=119) or hysterectomy (n=117). The amount of menstrual blood loss was objectively measured. The primary outcome measure was health-related quality of life at 12-month follow-up. Analyses were by intention to treat. FINDINGS: In the group assigned the levonorgestrel-releasing IUS, 24 (20%) women had had hysterectomy and 81 (68%) continued to use the system at 12 months. Of the women assigned to the hysterectomy group, 107 underwent the operation. Health-related quality of life improved significantly in both the IUS and hysterectomy groups (change 0.10 [95% CI 0.06-0.14] in both groups) as did other indices of psychological wellbeing. There were no significant differences between the treatment groups except that women with hysterectomy suffered less pain. Overall costs were about three times higher for the hysterectomy group than for the IUS group. INTERPRETATION: The significant improvement in health-related quality of life highlights the importance of treating menorrhagia. During the first year the levonorgestrel-releasing IUS was a cost-effective alternative to hysterectomy in treatment of this disorder.
Asunto(s)
Histerectomía , Levonorgestrel/administración & dosificación , Menorragia/terapia , Adulto , Ansiedad/etiología , Costo de Enfermedad , Análisis Costo-Beneficio , Preparaciones de Acción Retardada , Depresión/etiología , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Histerectomía/economía , Levonorgestrel/economía , Menorragia/economía , Menorragia/psicología , Salud Mental , Persona de Mediana Edad , Calidad de Vida , SexoRESUMEN
BACKGROUND: The study objective was to identify trends in the use of hysterectomy by nationwide register based analysis in Finland. METHODS: All women (n=89,069) undergoing hysterectomy in 1987-1995 according to the Finnish Hospital Discharge Register were the numerator. The annual denominator data were obtained from the population database of Statistics Finland. RESULTS: From 1987 to 1992 the hysterectomy rate increased by 22%, from 340 to 414 per 100,000 females, almost half of this being attributable to the changing age structure. From 1993 on, ambiguity in coding laparoscopically assisted vaginal hysterectomies prohibited detailed analyses. However, the overall trend continued at least among women 50 years and over until 1995. The age-adjusted 12% increase from 1987 to 1992 coincided with a rapid increase in operation rates in postmenopausal groups (60% or more among women aged 55 59 and 70-79 years). Among women aged 55-64 years, operations for fibroids and uterine bleeding more than doubled, suggesting an influence of increased use of estrogen replacement therapy. Among all women, operations due to bleeding disorders and genital prolapse showed the largest increase (41% and 42% respectively). Bilateral oophorectomy became more common in all age groups over 46 years. CONCLUSIONS: There was a modest increase in the overall hysterectomy rate. However, the operation became far more common in postmenopausal women, possibly due to the growing use of estrogen replacement therapy. Register data can be used for describing changes in clinical practice, but other methods are needed to confirm the causal relationships underlying the changes.