Cancer risk among women treated with levonorgestrel-releasing intrauterine system or endometrial ablation for heavy menstrual bleeding

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Heavy menstrual bleeding (HMB) is a common problem affecting up to one-third of women in their reproductive years. Modern intrauterine treatment modalities for HMB, namely levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial ablation, have changed significantly the management of HMB and resulted in a marked decrease in the number of hysterectomies in many countries. Despite the increasing popularity of these treatments, little is known about the cancer risks among women treated with these methods. Also, some women need a later hysterectomy after endometrial ablation, but factors predisposing to that are insufficiently known. In this thesis, cancer risks among Finnish women treated for HMB with LNG-IUS (93 843 women) or endometrial ablation (5 484 women) at ages 30-49 years, were assessed. Also, the risk factors for postablation hysterectomy were evaluated. The studies were based on nationwide register data. The use of LNG-IUS for HMB was associated with an increased risk of breast cancer, but a decreased risk of both endometrial and ovarian cancer. This means 2-4 excess cases of breast cancer per 1 000 LNG-IUS users followed for ten years. Also, this means 3-6 prevented endometrial cancers, and 3-6 prevented invasive ovarian cancers per 10 000 LNG-IUS users followed for ten years. Among women with endometrial ablation, the incidence of endometrial cancer or breast cancer after endometrial ablation was similar to that of the general population. Over 80% of endometrial ablation treated women did not need a later hysterectomy. The risk factors for postablation hysterectomy were leiomyomas, young age, and a history of two or more cesarean deliveries or sterilization. The results of this thesis revealed new information on the cancer risks among women treated for HMB with LNG-IUS or endometrial ablation. Both these methods for treatment of HMB are effective, but an individual risk–benefit assessment is important to do when deciding the treatment for HMB.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-3621-3
Electronic ISBNs978-951-51-3622-0
Publication statusPublished - 2017
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 3123 Gynaecology and paediatrics

Cite this

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title = "Cancer risk among women treated with levonorgestrel-releasing intrauterine system or endometrial ablation for heavy menstrual bleeding",
abstract = "Heavy menstrual bleeding (HMB) is a common problem affecting up to one-third of women in their reproductive years. Modern intrauterine treatment modalities for HMB, namely levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial ablation, have changed significantly the management of HMB and resulted in a marked decrease in the number of hysterectomies in many countries. Despite the increasing popularity of these treatments, little is known about the cancer risks among women treated with these methods. Also, some women need a later hysterectomy after endometrial ablation, but factors predisposing to that are insufficiently known. In this thesis, cancer risks among Finnish women treated for HMB with LNG-IUS (93 843 women) or endometrial ablation (5 484 women) at ages 30-49 years, were assessed. Also, the risk factors for postablation hysterectomy were evaluated. The studies were based on nationwide register data. The use of LNG-IUS for HMB was associated with an increased risk of breast cancer, but a decreased risk of both endometrial and ovarian cancer. This means 2-4 excess cases of breast cancer per 1 000 LNG-IUS users followed for ten years. Also, this means 3-6 prevented endometrial cancers, and 3-6 prevented invasive ovarian cancers per 10 000 LNG-IUS users followed for ten years. Among women with endometrial ablation, the incidence of endometrial cancer or breast cancer after endometrial ablation was similar to that of the general population. Over 80{\%} of endometrial ablation treated women did not need a later hysterectomy. The risk factors for postablation hysterectomy were leiomyomas, young age, and a history of two or more cesarean deliveries or sterilization. The results of this thesis revealed new information on the cancer risks among women treated for HMB with LNG-IUS or endometrial ablation. Both these methods for treatment of HMB are effective, but an individual risk–benefit assessment is important to do when deciding the treatment for HMB.",
keywords = "Breast Neoplasms, +chemically induced, +epidemiology, Contraceptive Agents, Female, +adverse effects, Endometrial Ablation Techniques, Endometrial Neoplasms, Fallopian Tube Neoplasms, Hysterectomy, +statistics & numerical data, Intrauterine Devices, Medicated, Incidence, Levonorgestrel, Menorrhagia, +drug therapy, +surgery, Neoplasms, Ovarian Neoplasms, Risk Factors, Registries, Uterine Neoplasms, 3123 Gynaecology and paediatrics",
author = "Tuuli Soini",
note = "M1 - 110 s. + liitteet",
year = "2017",
language = "English",
isbn = "978-951-51-3621-3",
publisher = "[T. Soini]",
address = "Finland",

}

Cancer risk among women treated with levonorgestrel-releasing intrauterine system or endometrial ablation for heavy menstrual bleeding. / Soini, Tuuli.

Helsinki : [T. Soini], 2017. 110 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Cancer risk among women treated with levonorgestrel-releasing intrauterine system or endometrial ablation for heavy menstrual bleeding

AU - Soini, Tuuli

N1 - M1 - 110 s. + liitteet

PY - 2017

Y1 - 2017

N2 - Heavy menstrual bleeding (HMB) is a common problem affecting up to one-third of women in their reproductive years. Modern intrauterine treatment modalities for HMB, namely levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial ablation, have changed significantly the management of HMB and resulted in a marked decrease in the number of hysterectomies in many countries. Despite the increasing popularity of these treatments, little is known about the cancer risks among women treated with these methods. Also, some women need a later hysterectomy after endometrial ablation, but factors predisposing to that are insufficiently known. In this thesis, cancer risks among Finnish women treated for HMB with LNG-IUS (93 843 women) or endometrial ablation (5 484 women) at ages 30-49 years, were assessed. Also, the risk factors for postablation hysterectomy were evaluated. The studies were based on nationwide register data. The use of LNG-IUS for HMB was associated with an increased risk of breast cancer, but a decreased risk of both endometrial and ovarian cancer. This means 2-4 excess cases of breast cancer per 1 000 LNG-IUS users followed for ten years. Also, this means 3-6 prevented endometrial cancers, and 3-6 prevented invasive ovarian cancers per 10 000 LNG-IUS users followed for ten years. Among women with endometrial ablation, the incidence of endometrial cancer or breast cancer after endometrial ablation was similar to that of the general population. Over 80% of endometrial ablation treated women did not need a later hysterectomy. The risk factors for postablation hysterectomy were leiomyomas, young age, and a history of two or more cesarean deliveries or sterilization. The results of this thesis revealed new information on the cancer risks among women treated for HMB with LNG-IUS or endometrial ablation. Both these methods for treatment of HMB are effective, but an individual risk–benefit assessment is important to do when deciding the treatment for HMB.

AB - Heavy menstrual bleeding (HMB) is a common problem affecting up to one-third of women in their reproductive years. Modern intrauterine treatment modalities for HMB, namely levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial ablation, have changed significantly the management of HMB and resulted in a marked decrease in the number of hysterectomies in many countries. Despite the increasing popularity of these treatments, little is known about the cancer risks among women treated with these methods. Also, some women need a later hysterectomy after endometrial ablation, but factors predisposing to that are insufficiently known. In this thesis, cancer risks among Finnish women treated for HMB with LNG-IUS (93 843 women) or endometrial ablation (5 484 women) at ages 30-49 years, were assessed. Also, the risk factors for postablation hysterectomy were evaluated. The studies were based on nationwide register data. The use of LNG-IUS for HMB was associated with an increased risk of breast cancer, but a decreased risk of both endometrial and ovarian cancer. This means 2-4 excess cases of breast cancer per 1 000 LNG-IUS users followed for ten years. Also, this means 3-6 prevented endometrial cancers, and 3-6 prevented invasive ovarian cancers per 10 000 LNG-IUS users followed for ten years. Among women with endometrial ablation, the incidence of endometrial cancer or breast cancer after endometrial ablation was similar to that of the general population. Over 80% of endometrial ablation treated women did not need a later hysterectomy. The risk factors for postablation hysterectomy were leiomyomas, young age, and a history of two or more cesarean deliveries or sterilization. The results of this thesis revealed new information on the cancer risks among women treated for HMB with LNG-IUS or endometrial ablation. Both these methods for treatment of HMB are effective, but an individual risk–benefit assessment is important to do when deciding the treatment for HMB.

KW - Breast Neoplasms

KW - +chemically induced

KW - +epidemiology

KW - Contraceptive Agents, Female

KW - +adverse effects

KW - Endometrial Ablation Techniques

KW - Endometrial Neoplasms

KW - Fallopian Tube Neoplasms

KW - Hysterectomy

KW - +statistics & numerical data

KW - Intrauterine Devices, Medicated

KW - Incidence

KW - Levonorgestrel

KW - Menorrhagia

KW - +drug therapy

KW - +surgery

KW - Neoplasms

KW - Ovarian Neoplasms

KW - Risk Factors

KW - Registries

KW - Uterine Neoplasms

KW - 3123 Gynaecology and paediatrics

M3 - Doctoral Thesis

SN - 978-951-51-3621-3

PB - [T. Soini]

CY - Helsinki

ER -