The effect of hysterectomy or levonorgestrel-releasing intrauterine system on cardiovascular disease risk factors in menorrhagia patients: a 10-year follow-up of a randomised trial.

Abstract

OBJECTIVE:

To compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up.

STUDY DESIGN:

A total of 236 women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality.

MAIN OUTCOME MEASURES:

Waist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed.

RESULTS:

After 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P=0.008 vs from 5.1% to 8.4%, P=0.08), as well as they had significantly higher serum levels of TNF-α (108.59 pg/ml vs 49.02 pg/ml, P=0.001) and hsCRP (1.55 μg/ml vs 0.78 μg/ml, P=0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids.

CONCLUSIONS:

Hysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events.

• Authors: S Heliövaara-Peippo, R Oksjoki, K Halmesmäki, R Kaaja, J Teperi, S Grenman, A Kivelä, H-M Surcel, E Tomas, M Tuppurainen, R Hurskainen, J Paavonen
• Journal: Maturitas (Maturitas) Vol. 69 Issue 4 Pg. 354-8 (Aug 2011) ISSN: 1873-4111 [Electronic] Ireland
• PMID: 21684096 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Hypoglycemic Agents
• Progestins
• Tumor Necrosis Factor-alpha
• Levonorgestrel
• C-Reactive Protein

Topics

• Adult
• C-Reactive Protein (metabolism)
• Cardiovascular Diseases (blood, etiology)
• Diabetes Mellitus (blood, drug therapy, etiology)
• Female
• Follow-Up Studies
• Humans
• Hypoglycemic Agents (therapeutic use)
• Hysterectomy (adverse effects)
• Inflammation (blood, complications)
• Intrauterine Devices, Medicated
• Levonorgestrel (adverse effects, therapeutic use)
• Menorrhagia (blood, therapy)
• Middle Aged
• Progestins (adverse effects, therapeutic use)
• Risk Factors
• Tumor Necrosis Factor-alpha (blood)