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

Amrita Chaurasia, Shweta Shweta, Vidhi Singh, Vandana Maurya, Ved P. Maurya
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(7) , pp. 2182–2187 · doi:10.18203/2320-1770.ijrcog20251963 · W4411679823
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Abstract

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.

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