THE LEVONORGESTREL INTRAUTERINE SYSTEM IN THE MANAGEMENT OF MENORRHAGIA

Objective To assess the effect of a levonorgestrel releasing intrauter ine system in the management of menorrhagia. Design A prospective stud y. Setting A district general hospital in South Wales. Methods Fifty w omen with a failed trial of medical therapy and awaiting hysterectomy or transcervical resection of the endometrium (TCRE) were treated with a levonorgestrel intrauterine system. The menstrual loss was estimate d using a modified pictorial chart together with a full blood count an d ferritin measurement preinsertion and at three and six to nine month s postinsertion. Results The menstrual loss was reduced to acceptable levels in 37 women at three months and a further four by six to nine m onths. In all, 41 patients were taken off the waiting list for surgery , four of whom became amenorrhoeic. There was no significant change in full blood count nor ferritin measurement despite unscheduled bleedin g for six to eight weeks postinsertion. Fifty-six percent of patients noticed considerable improvement or cure of their premenstrual syndrom e symptoms; 80% noted a reduction in dysmenorrhoea. Conclusion The lev onorgestrel releasing intrauterine system is an effective nonsurgical treatment for the management of menorrhagia and dysmenorrhoea that has additional benefit as a contraceptive and in relieving premenstrual s yndrome.