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Research

Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2202 (Published 26 April 2011) Cite this as: BMJ 2011;342:d2202

Mirena disadvantages omitted.

Dear Editor,

Mrs. Anna Filonenko, Dr. Pirjo Inki and Mr. Dominic Muston, in their
Rapid Response, stated that permanent loss of fertility should prevent
women from choosing hysterectomy.

All women included in this research were older than 42 years. There
is not much fertility left at 42 years of age, even for IVF specialists!

Available evidence shows that hysterectomy has been proven more
accepted and prefered than Mirena, even in 35 year old women. [1]

Apparently, just decreasing bleeding is not enough, as Mrs. Anna
Filonenko, Dr. Pirjo Inki and Mr. Dominic Muston, in their Rapid Response,
also admit!

In their Rapid Response these authors also arbitrary declare that
"women prefer a less invasive choice", which contradicts all available
research evidence. [1]

These authors also present studies from the Halmesm?ki K, et al
research group concluding that "hysterectomy causes more long term urinary
problems" , forgetting to present studies from the same research group
(!), published in the BJOG, which conclude that, despite everything, women
5 years after hysterectomy had a better sexual life, increased sexual
satisfaction, less hot flushes and less vaginal dryness compared to women
treated with Mirena, who actually witnessed their sexual lives deteriorate
even more! [1]

I am sure that sensitive computerized urogynecologic electronic
equipment used by the Halmesm?ki K, et al research group, must have
detected more urinary incontinence data in hysterectomized women, 10 years
after the operation. [2]

Obviously, these data could not be clinically important, because
these women reported a better quality of sexual life and increased sexual
satisfaction! [1]

There is "still no link between hysterectomy and incontinence"!
[3]

Many parameters have to be carefully evaluated when examining
incontinence after hysterectomy, as Dr. Mauricio Serati, Dr. Stefano
Salvatore and Dr. Pierfranco Bolis state in their Rapid Response. [4]

Furthermore, I could not find any scientific evidence that links a 5
minute vaginal hysterectomy, like the one performed here [5], to back pain
after 10 years.

If Mrs. Anna Filonenko, Dr. Pirjo Inki and Mr. Dominic Muston can
prove that these fast and effective surgical procedures are linked to back
pain (after 10 years!) and can explain the mechanism, I urge them to share
their data.

Finally, based on current medical research, what we can safely
conclude is that hysterectomy is cheaper, well tolerated, favored by women
and permanent solution for HMB compared to Mirena, for women older than 35
years.

[1] http://www.ncbi.nlm.nih.gov/pubmed/17439564
BJOG. 2007 May;114(5):563-8.

The effect of hysterectomy or levonorgestrel-releasing intrauterine
system on sexual functioning among women with menorrhagia: a 5-year
randomised controlled trial.
Halmesm?ki K, Hurskainen R, Teperi J, Grenman S, Kivel? A, Kujansuu E,
Tuppurainen M, Yliskoski M, Vuorma S, Paavonen J.

[2] Helioevaara-Peippo S, Halmesmaeki K, Hurskainen R, Teperi J,
Grenman S, Kivelae A, Tomas E, et al. 2010. The effect of hysterectomy or
levonorgestrel-releasing intrauterine system on lower urinary tract
symptoms: a 10-year follow-up study of a randomised trial. BJOG 117(5):
602-9.

[3] http://www.bmj.com/content/335/7626/908.2.extract?sid=22d5bb2d-
5a68-4d2c-9f75-4a755fdd6ef3

[4]
http://www.bmj.com/content/335/7626/908.2.extract/reply#bmj_el_180118

[5] http://www.youtube.com/watch?v=fdGNNeu746o

Competing interests: No competing interests

26 June 2011
Stavros Saripanidis
Consultant in Obstetrics and Gyneacology in Greece
Private Sector, 55131