Levonorgestrel intrauterine system for heavy menstrual bleeding: a real-world experience from a tertiary centre in Northern India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253099Keywords:
Fetal distress, Hypertension in pregnancy, StillbirthsAbstract
Background: Heavy menstrual bleeding (HMB) affects quality of life and health in reproductive-age women. Levonorgestrel intrauterine system (LNG-IUS) offers a conservative treatment option. This study aimed to evaluate the clinical efficacy and acceptability of LNG-IUS in women with HMB.
Methods: Retrospective analysis of 63 women (32-50 years) with HMB at Dr. RPGMC, Kangra, over two years. Follow-up was conducted at 1, 3, 6, and 12 months. Data included demographics, clinical presentation, hematological investigations, ultrasonographic findings, follow-up outcomes, and patient satisfaction scores.
Results: Mean age was 44.28 years; 50.79% were 45-50 years. Majority (68.25%) were para 2; 96.82% were married. Socioeconomic status varied, with 25.39% in the upper-lower class. The most common diagnosis was dysfunctional uterine bleeding (57.14%), followed by fibroid uterus (25.39%), adenomyosis (11.11%), and endometriosis (6.34%). Comorbidities included hypertension (15.87%) and diabetes (11.11%). Hemoglobin analysis showed moderate anemia in 52.38% and severe anemia in 26.98%. Bleeding patterns improved significantly: at 1 month, 57.14% had scanty flow; by 3 months, 74.60% reported reduced bleeding; at 6 months, 86.27% had scanty or no bleeding. By 12 months, 41.17% developed amenorrhea. Expulsion occurred in 2 cases; 2 others requested removal. Overall, 82.35% were satisfied with bleeding pattern; 98.03% had no dysmenorrhea. Social, sexual life, and mobility improved notably. Satisfaction assessment showed 80.38% of patients were either satisfied or very satisfied.
Conclusions: LNG-IUS is effective, safe, and well accepted for treating HMB, particularly in resource-limited settings. Its impact on reducing blood loss, correcting anemia, and improving life quality supports its wider use.
Metrics
References
Kaur H, Sikka P, Kaur T. Efficacy of LNG-IUS in heavy menstrual bleeding: a cohort study. Int J Reprod Contracept Obstet Gynecol. 2021;10(2):456-60. DOI: https://doi.org/10.18203/2320-1770.ijrcog20211417
Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods. Am J Obstet Gynecol. 2004;190(5):1216-23. DOI: https://doi.org/10.1016/j.ajog.2003.11.015
Cole SK, Billewicz WZ, Thomson AM. Sources of variation in menstrual blood loss. J Obstet Gynaecol Br Commonw. 1971;78:933-9. DOI: https://doi.org/10.1111/j.1471-0528.1971.tb00208.x
Janssen CA, Scholten PC, Heintz AP. Reconsidering menorrhagia in gynecological practice. Eur J Obstet Gynecol Reprod Biol. 1998;78:69-72. DOI: https://doi.org/10.1016/S0301-2115(97)00275-3
Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivelä A, et al. Clinical outcomes and costs with LNG-IUS or hysterectomy for menorrhagia: RCT 5-year follow-up. JAMA. 2004;291(12):1456-63. DOI: https://doi.org/10.1001/jama.291.12.1456
Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification (PALM-COEIN) for AUB. Int J Gynaecol Obstet. 2011;113(1):3-13. DOI: https://doi.org/10.1016/j.ijgo.2010.11.011
Kaunitz AM, Bissonnette F, Monteiro I. LNG-IUS vs medroxyprogesterone for HMB: RCT. Practice Bulletin No. 115: Vaginal Birth After Previous Cesarean Delivery. Obstet Gynecol. 2010;116(3):625-32. DOI: https://doi.org/10.1097/AOG.0b013e3181eeb251
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. LNG-IUS vs endometrial ablation in HMB: systematic review & meta-analysis. Obstet Gynecol. 2009;113(5):1104-16. DOI: https://doi.org/10.1097/AOG.0b013e3181a1d3ce
Kucuk T, Ertan K. Medroxyprogesterone acetate vs LNG-IUS in perimenopausal menorrhagia: RCT. Clin Exp Obstet Gynecol. 2008;35:57-60.
Senol T, Kahramanoglu I, Dogan Y, Baktiroglu M, Karateke A, Suer N. Levonorgestrel-releasing intrauterine device use as an alternative to surgical therapy for uterine leiomyoma. Clin Exp Obstet Gynecol. 2015;42(2):224-7. DOI: https://doi.org/10.12891/ceog1826.2015
Awasthi D, Kulshrestha V, Agarwal N. Efficacy of LNG-IUS in uterine leiomyoma. Int J Gynaecol Obstet. 2012;116(1):35-8. DOI: https://doi.org/10.1016/j.ijgo.2011.07.031
Sheng J, Zhang WY, Zhang JP, Lu D. LNG-IUS study on adenomyosis: 3-year follow-up. Contraception. 2009;79(3):189-93. DOI: https://doi.org/10.1016/j.contraception.2008.11.004
ockhat FB, Emembolu JO, Konje JC. Effectiveness of LNG-IUS in endometriosis. Hum Reprod. 2005;20(3):789-93. DOI: https://doi.org/10.1093/humrep/deh650
Tariq N, Ayub R, Jaffery T, Khan AT. Efficacy of LNG-IUS for AUB & contraception. J Coll Physicians Surg Pak. 2011;21(4):210-3.
Paula HB, Jeffrey TJ. LNG-IUS use: contraceptive & non-contraceptive benefits. Int J Womens Health. 2009;1:45-58.
Gorgen H, Api M, Akça A, Cetin A. Use of the Levonorgestrel-IUS in the treatment of menorrhagia: assessment of quality of life in Turkish users. Arch Gynecol Obstetr. 2009;279(6):835-40. DOI: https://doi.org/10.1007/s00404-008-0834-x
Lete I, Obispo C, Izaguirre F, Orte T, Rivero B, Cornellana MJ, Bermejo I, et al. The levonorgestrel intrauterine system (Mirena®) for treatment of idiopathic menorrhagia. Assessment of quality of life and satisfaction. The Europ J Contracep Reproduct Health Care. 2008;13(3):231-7. DOI: https://doi.org/10.1080/13625180802075075
Chen X, Liu Y, Peng Z. LNG-IUS vs medical therapies for HMB: systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2022;273:112-8.
Desai RM. LNG-IUS for menorrhagia due to benign uterine lesions in perimenopausal women. J Midlife Health. 2012;3(1):20-3. DOI: https://doi.org/10.4103/0976-7800.98812