Levonorgestrel-Releasing Intrauterine System Lessens Decrease Hysterectomy Rates in Finland

In the treatment of heavy menstrual bleeding, levonorgestrel-releasing intrauterine system (LNG-IUS) or hysterectomy improves equally health related quality of life, but the costs after 5 years are significantly lower in women whose treatment was started with IUS.

The VUOKKO-study was conducted between 1994-2002 in all five University Hospitals in Finland in co-operation with Stakes.

236 women referred for complaints of heavy menstrual bleeding to Finland's five university hospitals were randomly assigned to treatment with LNG-IUS (n=119), or hysterectomy (n=117).

The patients (99%) were monitored for 5 years to compare outcomes, quality of life issues, and costs. The LNG-IUS and hysterectomy groups did not differ substantially in terms of health related quality of life or psychosocial wellbeing (depression, anxiety and sexuality).

Although 42% of the women assigned to the LNG-IUS group eventually underwent hysterectomy, the discounted direct and indirect costs in the LNG-IUS group (US$2,817), remained substantially lower than in the hysterectomy group (US$4660).

Satisfaction with treatment was similar in both groups (more than 90%). Because menorrhagia is often a reason for seeking medical attention, it is important to consider the outcomes and costs of various treatment options to provide the most appropriate care.

By providing improvement in HRQL at relatively low cost, the LNG-IUS offers a wider availability of choices for the patient and decreases costs due to interventions involving surgery. In Finland, the LNG-IUS is widely accepted.

The national hysterectomy rate has declined by about 13% since 1998 suggesting that the use of LNG-IUS is already changing clinical practice.