RANDOMIZED COMPARATIVE TRIAL OF THE LEVONORGESTREL INTRAUTERINE SYSTEM AND NORETHISTERONE FOR TREATMENT OF IDIOPATHIC MENORRHAGIA

Objective To compare the efficacy and acceptability of the levonorgest rel intrauterine system and norethisterone for the treatment of idiopa thic menorrhagia. Design A randomised comparative parallel group study . Setting Gynaecology outpatient clinic in a teaching hospital. Partic ipants Forty-four women with heavy regular periods and a measured mens trual blood loss exceeding 80 ml. Methods Twenty-two women had a levon orgestrel intrauterine system inserted within the first seven days of menses, and 22 women received norethisterone (5 mg three times daily) from day 5 to day 26 of the cycle for three cycles. Main outcome measu res The main outcome measure was the change in objectively assessed me nstrual blood loss after three months of treatment. Results When menst rual blood loss at three months was expressed as a percentage of the c ontrol, the levonorgestrel intrauterine system reduced menstrual blood loss by 94% (median reduction 103 ml; range 70 to 733 ml), and oral n orethisterone by 87% (median reduction 95 ml; range 56 to 212 ml). Aft er three cycles of treatment 76% of the women in the levonorgestrel in trauterine system group wished to continue with the treatment, compare d with only 22% of the norethisterone group. Conclusions Both the levo norgestrel intrauterine system and oral norethisterone in this regimen provided an effective treatment for menorrhagia in terms of reducing menstrual blood loss to within normal limits. The levonorgestrel intra uterine system was associated with higher rates of satisfaction and co ntinuation with treatment, and thus offers an effective alternative to currently available medical and surgical treatments for menorrhagia.