A Drug-Releasing Intrauterine System Reduces Heavy Menstrual Bleeding

The efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the management of heavy menstrual bleeding appears to have similar therapeutic effects to that of endometrial ablation, according to a new study.

Researchers at the University of Florida College of Medicine (Jacksonville, USA) conducted a meta-analysis of six randomized clinical trials (three conducted in Western Europe and one each in New Zealand, Egypt, and Turkey), which compared LNG-IUS with endometrial ablation in the treatment of heavy menstrual bleeding up to January 2009. A total of 390 women were identified; of these, 196 women were treated with the LNG-IUS and 194 women received endometrial ablation. The primary study outcome was menstrual blood loss estimated with the pictorial bleeding assessment chart scores. A secondary outcome was treatment failures in both study groups, including unacceptable bleeding profile, persistent or recurrent heavy bleeding, major change in allocated treatment, removal of LNG-IUS, or repeated surgery.

The overall results of the study showed that both treatment modalities were associated with similar reductions in menstrual blood loss after six months, 12 months, and 24 months. Treatment failures did not appear to significantly differ between groups, at 21.2% for LNG-IUS compared with 17.9% for endometrial ablation. Both treatments were also generally associated with similar improvements in quality of life in the five studies that reported this outcome. Although no major complications occurred with either treatment in any of the trials, in the two studies that analyzed the occurrence of adverse events using statistical methods, nonserious adverse events were more frequently reported in the LNG-IUS group than in the endometrial ablation group. The study was published in the April 2009 issue of Obstetrics & Gynecology.

"We believe that the results...represent a valid comparison of the efficacy of LNG-IUS compared with both first- and second-generation endometrial ablation techniques,” conclude lead author Andrew Kaunitz, M.D., and colleagues of the department of obstetrics and gynecology. "In women choosing between insertion of a LNG-IUS and endometrial ablation, the need for contraception, risk of future pregnancy complications, and future ability to conceive, if desired, should be considered.”

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