Evaluation of quality of life and cost-effectiveness of definitive surgery and the levonorgestrel intrauterine system as treatment options for heavy menstrual bleeding

Abstract

A total of 104 patients aged 20-55 years, with complaints of regular HMB, were enrolled in the study from January 2013 to June 2015. Ninety-eight women completed the study. The inclusion criteria were the presence of HMB, reproductive age, a completed family, failure of appropriate first-line oral medical therapy, normal Pap smear, no pelvic pathology on ultrasound, normal endometrial biopsy, and pictorial blood loss assessment chart scores of ≥100 (average of two consecutive cycles). The exclusion criteria were previous endometrial resection/ablation, any uterine pathology on scans or hysteroscopy, incompletely investigated abnormal uterine bleeding, and postmenopausal bleeding. The local ethics committee approved this study.Background/aim: This study aimed to compare the levonorgestrel intrauterine system (LNG-IUS) with abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) as first-line treatments for heavy menstrual bleeding (HMB). Materials and methods:Ninety-eight patients aged 20-55 years who complained of regular heavy menstrual bleeding were enrolled in the study. The TAH group included 29 patients, the LNG-IUS group included 34, and the TLH group included 35. These groups were compared in terms of quality of life and the cost-effectiveness of the selected methods. Quality of life was assessed using the 36-Item Short Form (SF-36), and cost-effectiveness was assessed according to the current cost of each approach.

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

“…The mean duration of follow-up ranged from 49 to 57 months. A further 25 studies (including 1268 patients) met inclusion criteria for our additional population analogue, and described hysterectomy as a treatment of benign disease, specifically treatment of HMB/DUB [ 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ]. Fifteen studies reported on 9 randomised controlled trials (RCTs), and 8 studies reported on separate cohort studies.…”

“…Using the NOS, 2/2 cohort studies into RRH [ 31 , 34 ] revealed moderate risk of bias, due to the small sample in the assessed cohort versus the baseline population, and lack of baseline assessments. Eight cohort studies [ 69 , 72 , 73 , 74 , 82 , 83 , 84 , 87 ] into treatment of HMB/DUB were assessed with NOS; 7/8 studies revealed moderate risk of bias, in the lack of baseline assessments and assessments of outcome ( Table S4 ). The Jadad scale for randomised controlled trials demonstrated moderate risk of bias in 6/9 trials [ 63 , 68 , 70 , 75 , 77 , 80 , 81 , 85 , 86 ], predominantly due to lack of clarity on blinding ( Table S3 ).…”

“…A Turkish cohort study compared 32 patients treated for HMB with TAH, 37 patients with TLH, and 35 with LNG-IUS, measuring QoL using the SF-36 at 6 months’ follow-up [ 69 ]. BSO rates were not reported.…”

The levonorgestrel intrauterine system as an alternative to hysterectomy for treatment of abnormal uterine bleeding

“…[11][12][13][14] A observational study conducted by Tariq N to find out clinical response, side effects, and patients acceptability of levonorgestrel -releasing intrauterine system (LNG-IUS). 15,16 Adult women were enrolled, where two groups were enrolled where 57 women with abnormal uterine bleeding and 16 married woman for contraception.…”

Intrauterin Devices: What Has Changed?

“…Decreased hemoglobin concentration by 0.36 to 0.94 g/dL in one year period has been found in copper IUD users (53) Non-steroidal antiinflammatory drugs (NSAIDs) are recommended to alleviate menstrual blood and cramping pain. Hormonal IUDs reduce menstrual bleeding day and menstrual blood loss with LNG which suppresses endometrium that is sensitive to enlargement by ovarian estrogen (54,55).…”