The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review

Objective To determine whether the levonorgestrel-releasing intrauterine de vice (LNG-IUS). licensed at present for contraceptive use, may reduce menst rual blood loss with few side effects. If effective, surgery could be avoid ed with consequent resource savings. Methods A systematic review addressing the effectiveness and cost effective ness of the LNG-IUS for menorrhagia was undertaken. Results Five controlled trials and five case series were found which measur ed menstrual blood loss. Nine studies recorded statistically significant av erage menstrual blood loss reductions with LNG-IUS (range 74%-97%). Another showed reduction in menstrual disturbance score. The LNG-IUS was mere effe ctive than tranexamic acid, but slightly less effective than endometrial re section at reducing menstrual blued loss, In one study, 64% of women cancel led surgery at six months, compared with 14% of control group women. In ano ther, 82% were taken off surgical waiting lists at one year. No cost effect iveness studies were found. Discussion Small studies of moderate quality indicate the LNG-IUS is an eff ective treatment fur menorrhagia. Costs may be less than for tranexamic aci d in primary and secondary care. Although its use may reduce surgical waiti ng lists, cost effectiveness assessment requires longer follow up. Conclusion Effectiveness and cost effectiveness relative to other treatment s and the effect on surgical waiting lists can only be established in large r trials measuring patient-centred outcomes in women with menorrhagia.