Publication:

Efficacy of levonorgestrel intrauterine system in conservative management of abnormal uterine bleeding: an emerging tool

Background Intrauterine LNG IUS, introduced in 1990, reduces hysterectomies for abnormal uterine bleeding, reducing the need for costly and incapacitating surgical treatments.

Methods Heavy menstrual bleeding patients were prescribed oral progesterone therapy with norethisterone or medroxyprogesterone in doses of 20-60 mg daily for a maximum of 6 months. 80 patients chose oral progesterone and 40 chose LNG IUS insertion. The follow-up period for patients who chose LNG IUS was conducted at a rate of one year.

Results Reduction in PBAC score pre and post treatment was statistically significant in both oral progesterone (p value <0.001) and LNG IUS group (p value <0.001). We found statistically significant reduction in endometrial thickness after 6 months of treatment with oral progesterone (p value <0.001) and LNG IUS group (p value <0.001). The most common complaint at 6 months follow-up was spotting per vaginum, which was comparable in both groups. Infrequent cycle and secondary amenorrhea were significantly more in LNG IUS group (p value <0.05) whereas heavy flow persistence and need for hysterectomy were more in oral progesterone group (p value <0.05). LNG IUS got spontaneously expelled in one patient (2.5%) after first menstrual cycle. Mean duration from insertion to amenorrhea was 8 months. After insertion, the mean Hb% showed a significant rise of 8% form baseline. Satisfaction level was more (70%) in LNG IUS users in comparison to oral progesterone (15%).

Conclusions LNG-IUS is a superior nonsurgical option for managing HMB and uterine pathologies, with lower net costs compared to medical treatment and hysterectomy. It can be improved with counselling about self-remission of spotting per vaginum and fertility preservation.