The levonorgestrel intrauterine system in the management of menorrhagia

Abstract

Objective To assess the effect of a levonorgestrel releasing intrauterine system in the management of Design A prospective study.Setting A district general hospital in South Wales.Methods Fifty women with a failed trial of medical therapy and awaiting hysterectomy or transcervical resection of the endometrium (TCRE) were treated with a levonorgestrel intrauterine system. The menstrual loss was estimated using a modified pictorial chart together with a full blood count and ferritin measurement preinsertion and at three and six to nine months postinsertion. ResultsThe menstrual loss was reduced to acceptable levels in 37 women at three months and a further four by six to nine months. In all, 41 patients were taken off the waiting list for surgery, four of whom became amenorrhoeic. There was no significant change in full blood count nor ferritin measurement despite unscheduled bleeding for six to eight weeks postinsertion. Fifty-six percent of patients noticed considerable improvement or cure of their premenstrual syndrome symptoms; 80% noted a reduction in dysmenorrhoea. ConclusionThe levonorgestrel releasing intrauterine system is an effective nonsurgical treatment for the management of menorrhagia and dysmenorrhoea that has additional benefit as a contraceptive and in relieving premenstrual syndrome.menorrhagia.

Can the levonorgestrel intrauterine system replace surgical treatment for the management of menorrhagia?

“…In our study, the women reported an improvement in their symptoms of premenstrual tension. The reason for this improvement is difficult to understand as the amount of levonorgestrel entering the circulation is low but a similar improvement was reported in the earlier phase of the study 3 .…”

“…They were offered and accepted the LNG-IUS (Mirena: Schering Healthcare, UK ). All 50 women were sent a questionnaire including a pictorial menstrual chart at three months and after one year and these results have been published 3 . In this long term follow up study, the women were asked for information on their continued use of the LNG-IUS.…”

“…The levonorgestrel intrauterine system ( LNG-IUS) was initially developed as a contraceptive but it has been shown to be of proven use in reducing menstrual blood loss in the short term 3 . Previous studies have reported improvement in bleeding patterns between three months and a year of use 4 .…”

TCRE and Mirena: is the combination better?

“…Twelve percent of patients with a Mirena IUS in situ report no change in symptoms [10]. One disadvantage of the Mirena IUS is the erratic vaginal bleeding that may occur in the early months of its use.…”

The Management of Dysfunctional Uterine Bleeding

“…Although there was a higher rate of successful treatment in those undergoing transcervical resection or balloon ablation in four trials, rates of satisfaction and change in quality of life were similar, but women with levonorgestrel-releasing intrauterine system had a greater incidence of progestogenic side effects within a year. In two studies, 82% and 64% of women on a waiting list of hysterectomy cancelled their surgery after using levonorgestrel-releasing intrauterine system (Barrington & Bowen-Simpkins, 1997;Lähteenmaki et al, 1998). Another study comparing levonorgestrel-releasing intrauterine system with hysterectomy, revealed that there was no significant difference in quality of life scores, but the former treatment had lower costs than the latter (Hurskainen et al, 2001).…”