The effect of levonorgestrel-releasing intrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia

Koh SC, S C L Koh, S. Koh, K. Singh, Kuldip Singh, Singh K
Journal of thrombosis and haemostasis : JTH · 2006 · vol. 5(1) , pp. 133–138 · doi:10.1111/j.1538-7836.2006.02243.x · PMID:17010149 · W1488707730
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This study investigated how the levonorgestrel-releasing intrauterine system impacts menstrual blood loss and the hemostatic/fibrinolytic systems in women experiencing menorrhagia.

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Abstract

BACKGROUND: Menorrhagia is known to be associated with uterine fibroids, adenomyosis, pelvic infections, endometrial polyps and clotting defects. A viable alternative therapy to hysterectomy should alleviate heavy menstrual blood flow and consequently improve the quality-of-life measures in women presenting with menorrhagia. The levonorgestrel-releasing intrauterine system (LNG-IUS) ranks higher than medical treatments in terms of efficacy, comparable improvements in quality of life and psychological well-being. OBJECTIVE: The purpose of the study was to determine the effects of 6 months of LNG-IUS use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in blood and the endometrium in women with menorrhagia with known pathologic causes. PATIENTS AND METHODS: Samples from 41 women were analyzed. Hemoglobin, hematocrit, thrombelastography, tissue-type plasminogen activator (t-PA), urokinase plasminogen activator (u-PA), u-PA receptor (u-PAR), plasminogen activator inhibitor-1/2 (PAI-1/2), D-dimer and von Willebrand factor (VWF) were determined, and t-PA, u-PA and PAI-1/2 were also determined in endometrial tissue extracts. RESULTS: Menorrhagia was reduced in 89% of women by 3 months; by 6 months all women had no menorrhagia, and 39% of women had become amenorrhoeic. Hemoglobin and hematocrit levels showed improvement, and reached normal reference levels by 6 months. There were no systemic changes in the fibrinolytic/inhibitor systems and VWF, except for a decreased u-PAR level. However, in the endometrium, significant elevations in PAI-1/2 together with u-PAR levels were seen at 6 months. CONCLUSIONS: The slow levonorgestrel-release intrauterine device use results in high expression of fibrinolytic inhibitors (PAI-1/2) and upregulated u-PAR expression in the endometrium. Systemic hemostasis was not significantly altered. The study demonstrated that LNG-IUS is highly effective in the treatment of menorrhagia with known pathologic causes.

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MeSH descriptors

Contraceptives, Oral, Synthetic Fibrinolysis Intrauterine Devices, Medicated Intrauterine Devices, Medicated Levonorgestrel Menorrhagia Menstruation Adult Adult Contraceptives, Oral, Synthetic Contraceptives, Oral, Synthetic Contraceptives, Oral, Synthetic Contraceptives, Oral, Synthetic Endometrium Endometrium Endometrium Endometrium Erythrocyte Indices Erythrocyte Indices Female

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