The Effect of Hysterectomy or Levonorgestrel-Releasing Intrauterine, System on Lower Abdominal Pain and Back Pain Among Women Treated for Menorrhagia: A Five-Year Randomized Controlled Trial

Because hysterectomy, the standard treatment option for women of reproductive age with menorrhagia, is associated with serious complications and requires a relatively long-recovery period, the levonorgestrel-releasing intrauterine system (LNG-IUS) has been increasingly used as an alternative option. No randomized trials have compared these two treatment options on lower abdominal pain and back pain. A prior study comparing hysterectomy and LNG-IUS with respect to quality of life outcomes found that the only significant difference was that women with hysterectomy reported less pain after 12 months; this difference, however, disappeared at 5 years. This randomized controlled trial compared the effect of these two treatment procedures on lower abdominal pain and back pain among women of reproductive age treated for menorrhagia. Women aged 35 to 49 years were randomly assigned to treatment by hysterectomy (n = 117) or LNG-IUS (n = 119). Questionnaires were used to assess the frequency and intensity of lower abdominal pain and back pain at baseline and at 6 and 12 month, and 5-year follow-ups. At 6 months, women in both groups had significantly less frequent back pain compared to baseline (P < 0.001) with no difference between the groups. A decrease in lower abdominal pain at 6 months occurred only in the hysterectomy group (P = 0.02); the difference between the 2 groups was not significant (P = 0.5). From 12 months to 5 years, greater reductions were found in the LNG-IUS group in the frequency of lower abdominal pain (P = 0.05) and back pain (P = 0.002) than in the hysterectomy group. With respect to pain scores at 5 years, less lower abdominal pain was experienced among women in both groups compared to the baseline (P = 0.01) for the hysterectomy group and P < 0.001 for the LNG-IUS group). In contrast, the back pain score decreased only among women in the LNG-IUS group and the difference between the two groups was significant (P = 0.02). These findings show that both hysterectomy and LNG-IUS decrease lower abdominal pain in women of reproductive age treated for menorrhagia, but only LNG-IUS appears to have a beneficial effect on back pain.