Efficacy Of Therapeutic Levonorgestrel-releasing Intrauterine System Against Menorrhagia And Dysmenorrhea

Objective To assess the effectiveness of Levonorgestrel-releasing intrauterine system(LNG-IUS, Mirena) on menorrhagia and dysmenorrhea, and to compare LNG-IUS alone versus Gonadotropin releasing hormone agonist(Gn RHa) plus LNG-IUS in terms of effectiveness and side effects.Methods We conducted a review of 510 patients with adenomyosis, pelvic endometriosis or dysfunctional uterine bleeding who chose LNG-IUS insertion for reducing menstrual bleeding and/or relieving dysmenorrhea between July 2007 and October 2013. Their condition were followed up(range 3 days-92 months,the median follow-up duration was 21 months) and analyzed.Results 87.3%(339/388)patients with heavy menstrual bleeding had their menstrual bleeding reduced after inserting LNG-IUS, 87.3%(377/432)with dysmenorrheal had their pain eased. Among 510 patients, 87(17.1%) patients chose Gn RHa plus LNG-IUS and 423(82.9%)chose LNG-IUS alone after informed consent. Gn RHa combined with LNG-IUS demonstrated better efficiency both in controlling menstrual bleeding( 91.8%VS.86.5%, P=0.256) and in alleviating dysmenorrhea( 91.8%VS.86.5%, P=0.326) while with no statistical significance. Although similar spontaneous expulsion(9.2%VS.8.5%, P=0.836) was observed between the two groups, the duration to expulsion was delayed(median duration:10.5 months VS.3.5 months,P=0.041), and less patients were forced to remove LNG-IUS because of side effects or poor efficiency(3.4%VS.12.8%,P=0.02)in Gn RHa plus LNG-IUS group, and as a result a higher approval rate was noted in the same arm(86.2%VS.75.7%,P=0.032).Conclusions Besides the efficiency of contraception, LNG-IUS plays a theraputic role in managing menorrhagia and dysmenorrhea. Although no advantage of controlling the symptoms above could be found, the prolonged time to spontaneous expulsion, less rate of forced removal and higher rate of satisfaction were noticed in those who had LNG-IUS inserted followed by Gn RHa.