Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial

Am J Obstet Gynecol. 2013 Dec;209(6):535.e1-535.e14. doi: 10.1016/j.ajog.2013.08.041. Epub 2013 Aug 30.


Objective: Menorrhagia is a common problem impairing the quality of life (QOL) of many women. Both levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy are effective treatment modalities but no long-term comparative studies of QOL and costs exist. The objective of this study was to compare QOL and costs of LNG-IUS or hysterectomy in the treatment of menorrhagia during 10-year follow-up.

Study design: A total of 236 women, aged 35-49 years, referred for menorrhagia to 5 university hospitals in Finland were randomly assigned to treatment with LNG-IUS (n = 119) or hysterectomy (n = 117) and were monitored for 10 years. The main outcome measures were health-related QOL (HRQOL), psychosocial well-being, and cost-effectiveness.

Results: A total of 221 (94%) women were followed for 10 years. Although 55 (46%) women assigned to the LNG-IUS subsequently underwent hysterectomy, the overall costs in the LNG-IUS group ($3423) were substantially lower than in the hysterectomy group ($4937). Overall, levels of HRQOL and psychosocial well-being improved during first 5 years but diminished between 5 years and 10 years and the improved HRQOL returned close to the baseline level. There were no significant differences between LNG-IUS and hysterectomy groups.

Conclusion: Both LNG-IUS and hysterectomy improved HRQOL. The improvement was most striking during the first 5 years. Although many women eventually had hysterectomy, LNG-IUS remained cost-effective.

Keywords: cost-effectiveness; health-related quality of life; hysterectomy; levonorgestrel-releasing intrauterine system; menorrhagia.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / diagnosis
  • Cost-Benefit Analysis
  • Depression / diagnosis
  • Female
  • Follow-Up Studies
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Hysterectomy*
  • Levonorgestrel / administration & dosage
  • Levonorgestrel / therapeutic use*
  • Menorrhagia / drug therapy*
  • Menorrhagia / psychology
  • Menorrhagia / surgery
  • Middle Aged
  • Quality of Life*
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Treatment Outcome


  • Levonorgestrel