DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20211155

Levonorgestrel intrauterine system in menorrhagia-an effective and acceptable alternative

Barkha A. Bafna, Amit N. Bafna

Abstract


Background: To study the efficacy, performance and acceptability of levonorgestrel intrauterine device (LNG-IUS) in treatment of women with menorrhagia.

Methods: This was a descriptive, prospective and observational study conducted over a period of January 2015 to September 2020. Seventy-five (75) women presented with heavy menstrual bleeding having no contraindication for device underwent LNG-IUS insertion after consent. Menstrual pattern, pictorial blood loss assessment chart score (PBAC), rate of acceptability and satisfaction were recorded at 3 months, 6 months, 1, 2 and 3 years after insertion of LNG-IUS.

Results: The most common bleeding pattern at 3 month post-insertion was inter-menstrual spotting followed by infrequent menses, oligomenorrhea and amenorrhea. LNG-IUS caused 45.19% reduction in menstrual blood loss (MBL) at 3 months, 81.48% at 1 year, 91.85% at 2 years and 97% at 3 years. Hemoglobin levels improved from mean baseline 8.9 mg/l to 12.8 mg/l at 3 years. Majority of women were satisfied with this minimally-invasive treatment with continuation rate of 94.66%. No major side-effects were noted.

Conclusions: LNG-IUS is an excellent minimal invasive, highly effective in controlling blood loss and well-tolerated alternative for women with menorrhagia. Its fertility-sparing property makes it an emerging option for young women.

 


Keywords


Levonorgestrel intrauterine system, Menorrhagia, Pictorial blood loss assessment chart

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References


Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.

Wright RC. Hysterectomy: past, present, and future. Obstet Gynecol. 1969;33(4):560-3.

Goñi AZ, Lacruz RL, Paricio JJ, Hernández Rivas FJ. The levonorgestrel intrauterine system as an alternative to hysterectomy for the treatment of idiopathic menorrhagia. Gynecol Endocrinol. 2009;25(9):581-6.

Hubacher D, Grimes DA. Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv. 2002;57(2):120-8.

Taru G, Nupur G, Sangeeta G, Pushpa B, Jyoti J, Sushma K. (2014) Levonorgestrel intrauterine system (LNG IUS) in menorrahgia: a follow-up study. Open J Obstet Gynecol. 2014;4:190-6.

Utman N, Faheem F. Levenorgestrel intra utrine system (LNG IUS) in menorrhagia: a three years followup study. J Postgrad Med Inst. 2011;26(1).

Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, Muysers C, Jensen JT. Levonorgestrel-releasing intrauterine system or medroxyprogesterone for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(3):625-32.

Chattopdhyay B, Nigam A, Goswami S, Chakravarty PS. Clinical outcome of levonorgestrel intra-uterine system in idiopathic menorrhagia. Eur Rev Med Pharmacol Sci. 2011;15(7):764-8.

Dhamangaonkar PC, Anuradha K, Saxena A. Levonorgestrel intrauterine system (Mirena): an emerging tool for conservative treatment of abnormal uterine bleeding. J Midlife Health. 2015;6:26-30.

Endrikat J, Shapiro H, Lukkari-Lax E, Kunz M, Schmidt W, Fortier M. A Canadian, multicentre study comparing the efficacy of a levonorgestrel-releasing intrauterine system to an oral contraceptive in women with idiopathic menorrhagia. J Obstet Gynaecol Can. 2009;31(4):340-347.

Xiao B, Wu SC, Chong J, Zeng T, Han LH, Luukkainen T. Therapeutic effects of the levonorgestrel-releasing intrauterine system in the treatment of idiopathic menorrhagia. Fertil Steril. 2003;79(4):963-9.

Sushil K, Antony ZK, Mohindra V, Kapur A. Therapeutic use of LNG intrauterine system (Mirena) for menorrhagia due to benign lesions–an alternative to hysterectomy. J Obstet Gynecol India. 2005;55:541-3.

Kriplani A, Singh BM, Lal S, Agarwal N. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet. 2007;97(3):190-4.

Reid PC, Virtanen-Kari S. Randomized comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts. BJOG. 2005;112(8):1121-5.

Tariq N, Ayub R, Jaffery T, Rahim F, Naseem F, Kamal M. Efficacy of levonorgestrel intrauterine system (LNG-IUS) for abnormal uterine bleeding and contraception. J Coll Phys Surg Pak. 2011;21(4):210-3.

Vilos GA, Tureanu V, Garcia M, Abu-Rafea B. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. J Minim Invas Gynecol. 2009;16(4):480-4.

Rodriguez MI, Darney PD. Non-contraceptive applications of the levonorgestrel intrauterine system. Int J Wom Health. 2010;2:63-8.

Weiderpass E, Adami HO, Baron JA, Magnusson C, Bergström R, Lindgren A, et al. Risk of endometrial cancer following estrogen replacement with and without progestins. J Nat Cancer Inst. 1999;91(13):1131-7.

Orbo A, Vereide A, Arnes M, Pettersen I, Straume B. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: a national multicentre randomised trial. BJOG. 2014;121(4):477-86.

Mittermeier T, Farrant C, Wise MR. Levonorgestrel-releasing intrauterine system for endometrial hyperplasia. Cochrane Database Syst Rev. 2020;9:CD012658.