What is the role of the levonorgestrel intrauterine system in the treatment of menorrhagia?

Updated: Dec 20, 2018
  • Author: Julia A Shaw, MD, MBA, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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The levonorgestrel intrauterine system reduces menstrual blood loss by as much as 97% [32] It is comparable to transcervical resection of the endometrium for reduction of menstrual bleeding [33, 34, 35] Adverse effects include uterine bleeding or spotting, headache, ovarian cysts, vaginitis, dysmenorrhea, and breast tenderness.

A study by Kim et al indicated that the presence of a large myoma increases the likelihood of treatment failure with either thermal balloon ablation or the levonorgestrel intrauterine system. The study involved 106 women with menorrhagia and either intramural or submucosal myomas, including 67 patients who underwent thermal balloon ablation and 39 who were treated with the levonorgestrel intrauterine system; follow-up lasted more than 12 months. [36]

The investigators found that treatment failure (ie, hysterectomy at some time during follow-up or recurrence or persistence of menorrhagia within one year of treatment) for thermal balloon ablation for women with myomas of under 2.5 cm was 12%, compared with 28% for women with myomas that were less than 5 cm but greater than or equal to 2.5 cm, and 56% for women whose myomas were at least 5 cm in size. Those figures for women treated with the levonorgestrel intrauterine system were 14%, 29%, and 25%, respectively. [36]

In the ECLIPSE trial, which compared the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system with standard medical care (ie, tranexamic acid, mefenamic acid, combined oestrogen-progestogen or progesterone alone) for menorrhagia, investigators noted that although both treatment groups had improved scores as measured by the Menorrhagia Multi-Attribute Scale (MMAS), significantly greater improvement occurred in the levonorgestrel intrauterine system group over a 2-year period. [37] However, the differences between treatment groups were no longer significant at 5 years, and there was a similarly low proportion of women who required surgery in the groups. The investigators also indicated that the levonorgestrel intrauterine system was cost-effective in the short and medium term. [37]

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