Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding

Hurskainen R, Ritva Hurskainen, Jorma Paavonen, Paavonen J
Current opinion in obstetrics & gynecology · 2004 · vol. 16(6) , pp. 487–490 · doi:10.1097/00001703-200412000-00009 · PMID:15534445 · W1974373346
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The levonorgestrel-releasing intrauterine system effectively and affordably treats heavy menstrual bleeding, improving quality of life comparably to hysterectomy, with unscheduled bleeding as the main side effect.

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This review evaluates the levonorgestrel-releasing intrauterine system as a medical treatment for heavy menstrual bleeding, noting its effectiveness and cost-efficiency compared to hysterectomy. The authors highlight that while unscheduled breakthrough bleeding is the most common side effect, the treatment significantly improves health-related quality of life and allows approximately 60% of women to avoid surgery. A major caveat mentioned is that not all patients respond successfully to this therapy, requiring careful patient selection. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

PURPOSE OF REVIEW: Menorrhagia is a frequent reason for women to seek medical care and an increasingly common health problem. The levonorgestrel-releasing intrauterine system is an effective medical treatment for menorrhagia. Emerging clinical and research evidence suggests that this new treatment modality has major health benefits. RECENT FINDINGS: The levonorgestrel-releasing intrauterine system is a cost-effective treatment modality for menorrhagia. The quality of life improves significantly which is comparable to that gained with hysterectomy. The costs are about half those of hysterectomy after 5 years of follow-up. Unscheduled breakthrough bleeding is the most common side effect of the treatment. There are different new theories about the mechanism underlying this problem. Women with endometriosis or fibroids also benefit from this treatment. SUMMARY: Because menorrhagia is often a reason for seeking medical attention, it is important to consider the outcomes and costs to provide the most appropriate care. The levonorgestrel-releasing intrauterine system improves health-related quality of life significantly at relatively low cost. It is the most effective medical treatment for menorrhagia and comparable to surgical interventions. The system is not associated with serious complications. Although not all women are successfully treated, about 60% avoid hysterectomy and are satisfied with the treatment. Thus, the levonorgestrel-releasing intrauterine system should be the first line of treatment for heavy menstrual bleeding.
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Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding - Ritva Hurskainen - Jorma Paavonen Purpose of review Menorrhagia is a frequent reason for women to seek medical care and an increasingly common health problem. The levonorgestrel-releasing intrauterine system is an effective medical treatment for menorrhagia. Emerging clinical and research evidence suggests that this new treatment modality has major health benefits. Recent findings The levonorgestrel-releasing intrauterine system is a cost-effective treatment modality for menorrhagia. The quality of life improves significantly which is comparable to that gained with hysterectomy. The costs are about half those of hysterectomy after 5 years of follow-up. Unscheduled breakthrough bleeding is the most common side effect of the treatment. There are different new theories about the mechanism underlying this problem. Women with endometriosis or fibroids also benefit from this treatment. Summary Because menorrhagia is often a reason for seeking medical attention, it is important to consider the outcomes and costs to provide the most appropriate care. The levonorgestrel-releasing intrauterine system improves health-related quality of life significantly at relatively low cost. It is the most effective medical treatment for menorrhagia and comparable to surgical interventions. The system is not associated with serious complications. Although not all women are successfully treated, about 60% avoid hysterectomy and are satisfied with the treatment. Thus, the levonorgestrel-releasing intrauterine system should be the first line of treatment for heavy menstrual bleeding.

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Condition tags

endometriosis

MeSH descriptors

Contraceptive Agents, Female Intrauterine Devices, Medicated Intrauterine Devices, Medicated Levonorgestrel Menorrhagia Contraceptive Agents, Female Contraceptive Agents, Female Endometriosis Endometriosis Female Humans Leiomyoma Leiomyoma Levonorgestrel Levonorgestrel Menorrhagia

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References (28)

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