ACCEPTABILITY AND EFFICACY OF LEVONORGESTREL INTRAUTERINE DEVICE FOR TREATMENT OF MENORRHAGIA

Background: Menorrhagia or cyclic heavy menstrual bleeding (HMB) over several consecutive cycles during reproductive years is the most frequent form of dysfunctional uterine bleeding (DUB). Hysterectomy is often used to treat women with menorrhagia or HMB with high satisfaction rate and medical treatment can be considered a successful alternative therapy to hysterectomy. Levonorgestrel Intrauterine system (LNG-IUS) is a highly effective, long acting, reversible method of contraception, which offers additional health benefits and strong suppressive effect on the endometrium.
Objectives: This study was designed to evaluate the acceptability and efficacy of Levonorgestrel Intrauterine system as a method for treatment of menorrhagia.
Study Design: Prospective, observational, multicenter study, conducted in Ahmadi Hospital, Kuwait Oil Company (KOC), Kuwait and King Hussain Royal Medical Services (KH-RMS), Jordon, over two years.
Patients and Methods: One hundred and twenty (120) premenopausal women with menorrhagia were included in this study and they were counseled that their menstrual flow will decrease after insertion of LNG-IUS, but irregular spotting is common during first few months. LNG-IUS was inserted within the first 7 days of menses. Women were asked to mark in their menstrual diary, any changes in menstrual bleeding or pain following insertion. Primary outcome measures; acceptability of LNG-IUS as treatment for menorrhagia, while, secondary outcome measures; hemoglobin, ferritin, endometrial thickness and Doppler changes 3, 6 and 12 months after LNG-IUS insertion. Also, changes in general wellbeing and physical activity were assessed 3, 6 and 12 months after insertion of LNG-IUS.
Results: In 116 (96.7%) women, LNG-IUS was inserted easily without anesthesia. 12 months after insertion, LNG-IUS was accepted for treatment of menorrhagia in 115 (95.8%) women (70 (60.9%) women experienced amenorrhea, 38 (33.0%) women hypo-menorrhea and 7 (6.1%) women eumenorrhea). Pre-insertion serum hemoglobin and ferritin were significantly increased 6 and 12 months after LNG-IUS insertion. Pre-insertion endometrial thickness was significantly decreased 3, 6 and 12 months after LNG-IUS insertion (6.5±0.8, 5.6±1.1 and 4.6±0.7 mm; respectively) and pre-insertion sub-endometrial arteries Pulsatility index (PI) Resistance index (RI) were significantly increased 6 and 12 months after LNG-IUS insertion. Although, menstrual cramps were significantly decreased and quality of life was significantly improved after LNG-IUS insertion, LNG-IUS related side effects were recorded in 10 (8.7%) women.
Conclusion: LNG-IUS is an effective, acceptable alternative to hysterectomy for women with menorrhagia, if they are properly counseled about the possible side effects and intermenstrual spotting during first 3 months after insertion