The use of levonorgestrel‐releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders

Abstract

a Background The levonorgestrel-releasing intrauterine system (LNG-IUS) is used commonly by gynaecologists as a contraceptive and to treat menorrhagia. However, its efficacy has not been examined in women with inherited bleeding disorders. Design A prospective pilot study.Setting A teaching hospital in north London with a designated haemophilia centre.Population Female patients with a known inherited bleeding disorder.Methods Sixteen women with subjective and objective menorrhagia caused by inherited bleeding disorders (13 von Willebrand's Disease, two factor XI deficiency and one Hermansky -Pudlak syndrome), who had previously undergone unsuccessful medical treatment were followed up for nine months after LNG-IUS insertion. Bleeding was measured by pictorial chart and haemoglobin concentration. Results All women reported that their periods were improved, pictorial chart scores were lower and 56% became amenorrhoeic. None reported side effects. Conclusion The LNG-IUS is well tolerated and effective and improves quality of life.

How I treat type 2 variant forms of von Willebrand disease

“…A levonorgestrel-releasing intrauterine device (Mirena) may also be useful to control menorrhagia. 76 In conclusion, an array of tests, easily available even in nonspecialized laboratories, allows an accurate diagnosis and typing of the different forms of type 2 VWD. In variant forms of VWD, testing for desmopressin response is of greatest importance in either the propositus or related family members having the same VWF profile, as this compound may be conveniently used to treat common minor bleeding or procedures.…”

The obstetric and gynaecological management of women with inherited bleeding disorders – review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors’ Organization

“…The use of LNG-IUS in women with inherited bleeding disorders has been evaluated in 16 women (13 VWD, two FXI deficiency and one HermanskyPudlak syndrome) with menorrhagia not responding to medical treatment [218]. After 9 months, the PBAC score had decreased significantly from a median of 213 (range 98-386) to 47 (range and the haemoglobin concentrations had increased significantly from a median of 12.1 (range 8.0-13.2 g dL )1 ) to 13.1 (range 12.3-14 g dL…”

Principles of care for the diagnosis and treatment of von Willebrand disease

“…A levonorgestrel-releasing intrauterine device (Mirena®) has proved to be efficacious and safe in primary menorrhagia and has also been proposed for use in women with inherited bleeding disorders. 58 Endometrial ablation can also be used in older women without further reproductive needs. Iron supplementation is often required for patients with significant menorrhagia.…”