Medroxyprogesterone Eliminates Abnormal Bleeding With a Levonorgestrel Intrauterine System (LNG-IUS) [4P]

Abstract

INTRODUCTION: Abnormal vaginal bleeding is a common side effect seen in the majority of patients in the first six months after LNG-IUS placement. Some women may desire its removal because of this effect. The objective of this study was to assess the ability of medroxyprogesterone (MP) to reduce this initial bleeding transition period. METHODS: We prescribed a tapering regimen of medroxyprogesterone (MP) overlapping the first 35 days with the LNG-IUS. Four women who desired amenorrhea adhered to this regimen: on day three of their menses, they began a 14-day course of MP 10 mg daily; on day four, the LNG-IUS was inserted; on day 17, the MP was reduced to 5 mg daily for ten days; on day 27, the MP was reduced to 2.5 mg daily for ten days. The women were given a diary to record their bleeding pattern. RESULTS: All four women (100%) became amenorrheic within seven days of LNG-IUS insertion and remained so for the duration of use with the LNG-IUS (>1 year). Three out of four (75%) recorded 3-5 days of spotting for the first 1-4 months with the LNG-IUS. CONCLUSION: Our tapering regimen of MP overlapping the first 35 days with an LNG-IUS is sufficient to eliminate the initial period of abnormal bleeding. Iatrogenic amenorrhea may alleviate many patients' feelings of anxiety as well as other menstrual symptoms, and this may affect a patient's decision to continue using the LNG-IUS. More research is required to validate this study.