***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The purpose of this study was to compare the effects of hysterectomy and a levonorgestrel-releasing intrauterine system ( LNG-IUS ) on serum FSH levels and menopausal symptoms . METHODS A total of 236 women referred for menorrhagia to five university hospitals were r and omly assigned to treatment with hysterectomy ( n = 117 ) or LNG-IUS ( n = 119 ) . Menopausal symptoms were characterized by the Kupperman menopausal distress test . Serum FSH and estradiol levels were measured at baseline and 6 and 12 months after hysterectomy or application of LNG-IUS . Analyses were by intention to treat . RESULTS After 6 months , there was no difference between the groups , but 12 months after follow-up hysterectomized women had higher FSH levels than women with LNG-IUS ( P = 0.005 ) . There was a significant association between FSH levels and treatment modality ( P = 0.020 ) . Hot flushes increased significantly in the hysterectomy group ( P = 0.02 ) . There was a significant association between hot flushes and both treatment modality and age ( P = 0.02 and P = 0.01 , respectively ) . CONCLUSION Hysterectomy may impair ovarian function shown by rising serum FSH levels and hot flushes . However , these results should be interpreted with caution , and longer follow-up is needed OBJECTIVE Treatment of menorrhagia with levonorgestrel intrauterine system ( LNG IUS ) and transcervical resection . DESIGN An open , therapeutic , r and omized study . SETTING Central county hospital specializing in hysteroscopy . PATIENT(S ) Two parallel groups of 30 subjects each . INTERVENTION(S ) Thirty patients had a LNG IUS inserted within the first 7 days of menses ; 29 patients underwent endometrial resection .  MAIN OUTCOME MEASURE(S ) A 12-month follow-up of menstrual blood loss and adverse events were evaluated . RESULT ( S ) LNG IUS group : 13 patients reported one or more pelvic adverse events , bleeding disorders ( n = 6 ) , abdominal pain ( n = 4 ) , breast tenderness ( n = 3 ) , headache , acne ( n = 2 ) , and mood changes ( n = 1 ) . Six patients discontinued treatment because of irregular bleeding ( n = 3 ) , pain ( n = 2 ) , and acne ( n = 1 ) . In both groups , general feeling of genital health increased with Visual Analogue Scale score . Nine patients reported adverse events . This included pelvic pain indicating inflammation ( n = 4 ) , bleeding ( n = 3 ) , vaginitis ( n = 1 ) , and ulceration ( n = 1 ) . Treatment success at 12 months was achieved in 20 ( 67 % ) of the 30 patients in the LNG IUS group and in 26 ( 90 % ) of the 29 patients in the transcervical resection group . Adverse events were more often reported in the LNG IUS group . CONCLUSION ( S ) Both treatments effectively reduced the menstrual blood loss . Furthermore , the LNG IUS treatment is reversible and has no operative hazards CONTEXT Because menorrhagia is often a reason for seeking medical attention , it is important to consider outcomes and costs associated with alternative treatment modalities . Both the levonorgestrel-releasing intrauterine system ( LNG-IUS ) and hysterectomy have proven effective for treatment of menorrhagia but there are no long-term comparative studies measuring cost and quality of life . OBJECTIVE To compare outcomes , quality -of-life issues , and costs of the LNG-IUS vs hysterectomy in the treatment of menorrhagia . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted between October 1 , 1994 , and October 6 , 2002 , and enrolling 236 women ( mean [ SD ] age , 43 [ 3.4 ] years ) referred to 5 university hospitals in Finl and for complaints of menorrhagia . INTERVENTIONS Participants were r and omly assigned to treatment with the LNG-IUS ( n = 119 ) or hysterectomy ( n = 117 ) and were monitored for 5 years . MAIN OUTCOME MEASURES Health-related quality of life ( HRQL ) as measured by the 5-Dimensional EuroQol and the R AND 36-Item Short-Form Health Survey , other measures of psychosocial well-being ( anxiety , depression , and sexual function ) , and costs . RESULTS After 5 years of follow-up , 232 women ( 99 % ) were analyzed for the primary outcomes . The 2 groups did not differ substantially in terms of HRQL or psychosocial well-being . Although 50 ( 42 % ) of the women assigned to the LNG-IUS group eventually underwent  hysterectomy  , the discounted direct and indirect costs in the LNG-IUS group ( 2817 dollars [ 95 % confidence interval , 2222 dollars-3530 dollars ] per participant ) remained substantially lower than in the hysterectomy group ( 4660 dollars [ 95 % confidence interval , 4014 dollars-5180 dollars ] ) . Satisfaction with treatment was similar in both groups . CONCLUSIONS By providing improvement in HRQL at relatively low cost , the LNG-IUS may offer a wider availability of choices for the patient and may decrease costs due to interventions involving surgery STUDY OBJECTIVES To determine the safety and efficacy of endometrial resection , and to provide an indicator of the operative problems and treatment outcomes . DESIGN Prospect i ve study . SETTING Academic practice tertiary care setting . PATIENTS One hundred twenty-six consecutive women undergoing endometrial resection because of menorrhagia , who wished to retain their uterus . INTERVENTION Hysteroscopic endometrial resection performed as a day procedure . MEASUREMENTS AND MAIN RESULTS In 126 women , 2 cases of uterine perforation were readily identified on the operating monitor screen ; they had no serious sequelae . Three patients had heavy uterine bleeding , which was controlled by intrauterine tamponade . No women had other serious complications . CONCLUSION Hysteroscopic endometrial resection is a safe , successful , and cost-effective treatment of menorrhagia OBJECTIVE : The purpose of this study was to compare the long-term efficacy of the levonorgestrel intrauterine system and transcervical resection of the endometrium in the treatment of menorrhagia . METHODS : This study was an open , r and omized 3-year trial . Patients with menorrhagia were assigned r and omly to either the levonorgestrel intrauterine system ( n = 30 ) or endometrial resection ( n = 29 ) . Pictorial blood loss assessment charts were used to measure menstrual blood loss . A pictorial blood-loss assessment chart score exceeding 75 ( representing menstrual blood loss ≥60 mL ) was used to diagnosis the patient as having menorrhagia . Discontinuations and cases requiring repeat operations were evaluated . RESULTS : Pictorial blood loss scores decreased from a baseline median of 261.5 ( range , 60–1503 ) to 7 ( range , 0–101 ; P < .001 ) for the levonorgestrel intrauterine system and from 311 ( range , 81–2506 ) to 4 ( range , 0–182 ; P < .001 ) for transcervical resection of the endometrium . Nineteen women of 30 using the levonorgestrel intrauterine system completed the 3-year follow-up compared with 22 of 29 for transcervical resection of the endometrium . CONCLUSION : Both treatments efficiently reduced menstrual bleeding . The high continuation rate suggests that the levonorgestrel intrauterine system is comparable with transcervical resection of the endometrium . LEVEL OF EVIDENCE : Objective To compare the effect of a levonorgestrel-releasing intrauterine device with that of endometrial resection on menstrual bleeding , patient satisfaction , and quality of life in menorrhagic women during 12 months of followup . Methods Seventy premenopausal women with dysfunctional uterine bleeding were enrolled in a prospect i ve , open , parallel-group , controlled trial . They were r and omized to either insertion of an intrauterine system releasing 20 μg/day of levonorgestrel ( n = 35 ) or endometrial resection ( n = 35 ) . The women were evaluated at baseline , and thereafter , uterine bleeding was assessed monthly with a pictorial blood loss assessment chart . Clinical gynecologic examination was performed bimonthly , and the hematologic variables were measured at 6 and 12 months . On the latter occasion , the women were requested to rate the degree of satisfaction with the effect of their treatment and to complete the Short Form 36 General Health Survey question naire . Results Recurrent menorrhagia was observed at 12 months in four women in the intrauterine device group ( including two with partial expulsion of the device ) and in three women in the resection group . Compared with baseline values , at 1 year , the pictorial blood loss assessment chart score was reduced by 79 % in the former group and by 89 % in the latter . Amenorrhea or hypomenorrhea at 12 months was reported by 65 % of the women with an intrauterine device compared with 71 % who underwent endometrial resection . The degree of satisfaction with treatment was high in both groups , with 29 of 34 ( 85 % ) women being satisfied or very satisfied in the intrauterine device group versus 33 of 35 ( 94 % ) in the resection group . Health-related quality of life perception was not significantly different in the two treatment groups . Conclusion Somewhat less satisfactory results were obtained with a levonorgestrel-releasing intrauterine system compared with endometrial resection  for dysfunctional uterine bleeding at 1 year of follow-up In a community survey  521 women aged 35 - 59 were selected at r and om from all patients registered in two groups practice s. They were interviewed at home and assessed by means of st and ardised psychiatric measures and detailed gynaecological inquiry . Levels of psychiatric morbidity were found to be within the expected range for such a sample . Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms , including dysmenorrhoea and premenstrual tension , some symptoms of excessive menstruation , and flushes and sweats but not disappearance of menstruation for over six months . Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability ( neuroticism and previous psychiatric history ) , suggesting possible aetiological links with gynaecological symptoms . The findings of this study have implication s for the management of gynaecological complaints in general practice CONTEXT Although a quarter of US women undergo elective hysterectomy before menopause , controlled trials that evaluate the benefits and harms are lacking . OBJECTIVE To compare the effect of hysterectomy vs exp and ed medical treatment on health-related quality of life . DESIGN , SETTING , AND PARTICIPANTS A multicenter , r and omized controlled trial ( August 1997-December 2000 ) of 63 premenopausal women , aged 30 to 50 years , with abnormal uterine bleeding for a median of 4 years who were dissatisfied with medical treatments , including medroxyprogesterone acetate . The participants , who were patients at gynecology clinics and affiliated practice s of 4 US academic medical centers , were followed up for 2 years . INTERVENTIONS Participants were r and omly assigned to undergo hysterectomy or exp and ed medical treatment with estrogen and /or progesterone and /or a prostagl and in synthetase inhibitor . The hysterectomy route and medical regimen were determined by the participating gynecologist . MAIN OUTCOME MEASURES The primary outcome was mental health measured by the Mental Component Summary ( MCS ) of the 36-Item Short-Form Health Survey ( SF-36 ) . Secondary outcomes included physical health measured by the Physical Component Summary ( PCS ) , symptom resolution and satisfaction , body image , and sexual functioning , as well as other aspects of mental health and general health perceptions . RESULTS At 6 months , women in the hysterectomy group had greater improvement in MCS scores than women in the medicine group ( 8 vs 2 , P = .04 ) . They also had greater improvement in symptom resolution ( 75 vs 29 , P<.001 ) , symptom satisfaction ( 44 vs 7 , P<.001 ) , interference with sex ( 41 vs 22 , P = .003 ) , sexual desire ( 21 vs 3 , P = .01 ) , health distress ( 33 vs 13 , P = .009 ) , sleep problems ( 13 vs 1 , P = .03 ) , overall health ( 12 vs 2 , P = .006 ) , and satisfaction with health ( 31 vs 14 , P = .01 ) . By the end of the study , 17 ( 53 % ) of the women in the medicine group had requested and received hysterectomy , and these women reported improvements in quality -of-life outcomes during the 2 years that were similar to those reported by women r and omized to the hysterectomy group . Women who continued medical treatment also reported some improvements ( P<.001 for within-group change in many outcomes ) , with 
    Output:
    
Hysterectomy stopped all bleeding but caused serious complications for some women .
REVIEW ER 'S CONCLUSIONS Surgery reduces menstrual bleeding at one year more than medical treatments , but LNG-IUS appears equally beneficial in improving quality of life and may control bleeding as effectively as conservative surgery over the long term .
Oral medication suits a minority of women long term