Randomised comparative trial of the intrauterine system and norethisterone levonor gestrel for treatment of idiopathic menorrhagia

Abstract

Objective To compare the efficacy and acceptability of the levonorgestrel intrauterine system and Design A randomised comparative parallel group study. Setting Gynaecology outpatient clinic in a teaching hospital. Participants Forty-four women with heavy regular periods and a measured menstrual blood loss exceeding 80 ml. Methods Twenty-two women had a levonorgestrel intrauterine system inserted within the first seven days of menses, and 22 women received norethisterone (5 mg three times daily) from day 5 to day 26 of the cycle for three cycles. Main outcome measures The main outcome measure was the change in objectively assessed menstrual blood loss after three months of treatment.Results When menstrual blood loss at three months was expressed as a percentage of the control, the levonorgestrel intrauterine system reduced menstrual blood loss by 94% (median reduction 103 ml; range 70 to 733 ml), and oral norethisterone by 87% (median reduction 95 ml; range 56 to 212 ml). After three cycles of treatment 76% of the women in the levonorgestrel intrauterine system group wished to continue with the treatment, compared with only 22% of the norethisterone group. Conclusions Both the levonorgestrel intrauterine system and oral norethisterone in this regimen provided an effective treatment for menorrhagia in terms of reducing menstrual blood loss to within normal limits. The levonorgestrel intrauterine system was associated with higher rates of satisfaction and continuation with treatment, and thus offers an effective alternative to currently available medical and surgical treatments for menorrhagia.norethisterone for the treatment of idiopathic menorrhagia.

Comparison of the efficacy and safety of norethisterone vs combined oral contraceptive pills for the management of puberty menorrhagia

“…[12][13][14][15] This study demonstrates that norethisterone or COC pills-mediated improvements in menorrhagia extend to adolescents. Progesterone can be used cyclically in two different treatment Protocols-as short course during luteal phase and a relatively longer course lasting 21 days from day 5 of cycle.…”

Levonorgestrel intrauterine system: A first line medical therapy for idiopathic heavy menstrual bleeding

“…The LNG-IUS was found to be more effective than tranexamic acid. 9 In a comparative study, Irvine et al (1998), reported that LNG-IUS was effective in reducing menstrual blood loss by 94% compared to 87% by oral norethisterone. The patient satisfaction rate with LNG-IUS was higher compared to oral norethisterone.…”

“…The patient satisfaction rate with LNG-IUS was higher compared to oral norethisterone. 12 In a pilot, non-comparative study, Montereio I et al (2002) evaluated the efficacy and performance of an intrauterine system releasing levonorgestrel (LNG-IUS, Mirena) 20 microgm/day for up to one year in the treatment of 44 adult women with menorrhagia. 13 These patients were inserted LNG-IUS after the failure of other medical therapies.…”

“…12,[14][15][16] Use of LNG-IUS in patients of menorrhagia has shown to result in higher hemoglobin and serum ferritin levels compared to oral MPA. At cycle six, percentage of women with improved bleeding was much higher with the LNG-IUS compared to oral MPA as assessed by both investigator (93.6% vs. 61.0%) as well as patients (93.6% vs. 67.1%).…”

Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

“…Studies report reduction of blood loss in menstrual cycles up to 97%, with its maximum efficacy 1 year after insertion [24,[28][29][30][31]. The majority of women with Mirena® bleed only for 1 day or experience just spotting during their period, while 15% of them become amenorrheic [31].…”