ENORRHAGIA IS AN IMPORtant cause of ill health in women worldwide. A b o u t o n e t h i r d o f women report heavy menstrual bleeding at some time in their lives. 1 Menorrhagia is the presenting symptom among the majority of women who undergo hysterectomy, 2,3 and recent data suggest that menorrhagia is an increasingly common health problem. 4 The levonorgestrel-releasing intrauterine system (LNG-IUS) (Schering Co, Turku, Finland) has been advocated for the treatment of menorrhagia as an alternative to surgery. 5 The LNG-IUS is an intrauterine system that releases 20 µg of levonorgestrel every 24 hours over 5 years. The LNG-IUS was developed during the 1980s and licensed first for contraception in Finland in 1990. The estimated number of current LNG-IUS users worldwide is

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The validity of the 1991 Finnish Medical Birth Registry data was assessed, with special emphasis on the effects of changes made to the data collection form in 1990. Data abstracted from medical records for all births occurring in 49 hospitals during a five-day sample period (n = 865) were compared to the register information. Good or satisfactory validity was found for 32 of 33 variables, when minor error was tolerated in variables with continuous scales. For diagnoses and procedures, recorded in check-box format, satisfactory validity was found for 10 of 45 variables. Validity could not be assessed for 18 variables because of insufficient number of cases (13 items) or definition problems (5 items). When the results were compared to a 1987 data quality study, many of the variables that had been changed to the check-box format showed improvement in validity. In addition, in some cases a small change in question alternatives or instructions caused a noticeable change in validity.

Objective-To assess comprehensively the validity of the data in the Finnish Medical Birth Registry (MBR) by the combined use of several controls and internal analysis of the data. Design-The MBR data were individually linked to a medical record sample (n=775) and to all perinatal death certificates in 1987. The data were also compared with annual hospital statistics. The key issue in making large medical information systems cost effective is the utility of the gathered data. In many registries on perinatal health, a high rate of non-recording among selected subpopulations has often caused a fundamental data quality problem. In data collection systems in which more than 20% of neonates who die are not registered, for example,' it is obvious that the utility of the data is seriously compromised.Another problem reported repeatedly is the validity of the recorded information in perinatal databases. For example, data on one of the most important correlates of newborns' health, the length of gestation, are almost useless when 84% of all births are recorded as taking place at either 36 or 40 weeks.2 Research on specific diseases responsible for stillbirths is hampered if fewer than one quarter of the diagnoses on fetal death reports are relevant.3

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Objective To evaluate the effects of a decision aid for menorrhagia on treatment outcomes and costs over a 12-month follow-up.Design Randomized trial and pre-trial prospective cohort study. Setting and participants Gynaecology outpatient clinics in 14Finnish hospitals, 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia.Intervention A decision aid booklet explaining menorrhagia and treatment options, mailed to patients before their first clinic appointment.Main outcome measures Health related quality of life, psychological well-being, menstrual symptoms, satisfaction with treatment outcome, use and cost of health care services.Results All study groups experienced overall improvement in healthrelated quality of life, anxiety, and psychosomatic and menstrual symptoms, but not in sexual life. Treatment in the intervention group was more active than in the control group, with more frequent course of medication and less undecided treatments. However, there were no marked disparities in health outcomes, satisfaction with treatment outcome and costs. Total costs (including productivity loss) per woman because of menorrhagia over the 12-month follow-up were 2760ð and 3094ð in the intervention and control group, respectively (P ¼ 0.1). The pre-trial group also had a significantly lower rate of uterus saving surgery compared with the control group, but no difference in costs because of menorrhagia treatment.Conclusion Despite some differences in treatment courses, a decision aid for menorrhagia in booklet form did not increase the use of health services or treatment costs, nor had it impact on health outcomes or satisfaction with outcome of treatment.

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.Keywords Hysterectomy, LNG-IUS, menorrhagia, sexual functioning, sexuality.Please cite this paper as: Halmesmäki K, Hurskainen R, Teperi J, Grenman S, Kivelä A, Kujansuu E, Tuppurainen M, Yliskoski M, Vuorma S, Paavonen J. The effect of hysterectomy or levonorgestrel-releasing intrauterine system on sexual functioning among women with menorrhagia: a 5-year randomised controlled trial.

LNG-IUS use in the treatment of menorrhagia was associated with the development of ovarian cysts, but these were symptomless and showed a high rate of spontaneous resolution. LNG-IUS did not affect the size of the uterus or the size of uterine fibroids, but decreased the thickness of the endometrium.