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Objective. The purpose of this study was to evaluate the changes in lower abdominal pain and back pain among women with menorrhagia treated by hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS). Design. A randomized controlled trial. Setting. Five university hospitals in Finland. Sample. A total of 236 women, aged 35–49 years. Methods. Women were randomly assigned to treatment by hysterectomy ( n = 117) or LNG-IUS ( n = 119). Main outcome measures. Frequency and intensity of lower abdominal pain and back pain were evaluated by questionnaires at baseline and after 6 months, 12 months and 5 years. Results. By six months, women in both groups had less frequent back pain than before treatment ( p < 0.001). Lower abdominal pain decreased only in the hysterectomy group ( p = 0.02) with significant differences between the groups. Between 12 months and 5 years, frequency of lower abdominal pain ( p = 0.05) and back pain ( p = 0.002) decreased more in the LNG-IUS group than in the hysterectomy group. Between baseline and five years, the lower abdominal pain score (including frequency and intensity of pain) decreased in both groups ( p < 0.001, p = 0.01). Back pain score decreased only in the LNG-IUS group and the difference between the groups was significant ( p = 0.02). However, some women experienced more pain after both treatments than before treatment. In multivariate analyses, LNG-IUS use was associated with a decrease in lower abdominal pain and back pain. Conclusions. In the treatment of menorrhagia, both hysterectomy and LNG-IUS decrease lower abdominal pain. LNG-IUS use, but not hysterectomy, has beneficial effects on back pain. [ABSTRACT FROM AUTHOR]

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 14 Finnish 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, psycho- logical well-being, menstrual symptoms, satisfaction with treatment outcome, use and cost of health care services. Results: All study groups experienced overall improvement in health- related 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 I 2-month follow-up were 2760€ and 3094€ in the intervention and control group, respectively (P = 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. [ABSTRACT FROM AUTHOR]

Does a patient information booklet influence treatment for menorrhagia? Randomized trial and a pre-trial prospective cohort study. Gynaecology outpatient clinics in 14 Finnish hospitals. A total of 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia. An information booklet about menorrhagia and treatment options, mailed before the first visit to the outpatient clinic. Distribution of treatment modalities, knowledge about treatment options, satisfaction with communication with personnel and anxiety. Treatment decision within 3 months was made more often in the intervention group than in the control group (96% and 89% respectively, P = 0.02). Oral medication was more frequently chosen, and newly introduced treatments (minor surgery, hormonal intrauterine system) were less frequently used in the intervention group (at 3-month follow-up 21% and 29%, respectively). The differences persisted at the 12-month follow-up. In the pre-trial group, new treatment methods were less frequently chosen and used than in the control group. Additional information did not increase the number of surgical procedures used, improve knowledge, or influence satisfaction or anxiety. Additional information led to an increase in specific treatment decisions and changed the distribution of used treatments without increasing the number of surgical procedures. The study suggests that well-informed women adopting an active role may counteract physicians’ emphasis on newly introduced treatments. [ABSTRACT FROM AUTHOR]