Use of the levonorgestrel-releasing intrauterine system in women with hemostatic disorders

Objective: To evaluate the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in women with known hemostatic disorders and abnormal uterine bleeding. Design: Retrospective case series. Setting: Tertiary medical center. Patient(s): Women with regular, heavy menstrual bleeding who have von Willebrand's disease and/or are receiving anticoagulation therapy for a thrombotic disorder. Interventien(S): Levonorgestrel intrauterine system. Main Outcome Measure(s): Impact on menstrual bleeding and quality of life. Result(s): Seven women with hemostatic disorders who had used the LNG-IUS were identified. All 7 women completed the survey. Median age was 38 years (range 28-48 years). Six women were white, 1 woman was black. Four women had von Willebrand's disease. Four women were using anticoagulation, 3 warfarin, and 2 aspirin. One woman had both von Willebrand's disease and was heterozygous for factor V Leiden. All 7 women had heavy menstrual bleeding. After placement of the LNG-IUS, a decrease in number of bleeding days was seen in 71% of subjects (5 of 7), with overall median days reduced from 9 to 3 days. One subject discontinued use of the LNG-IUS because she desired pregnancy. Two subjects (29%) had no benefit from the LNG-IUS. Quality of life improved after placement of the LNG-IUS. Conclusion(s): The LNG-IUS seems to be an effective treatment for heavy menses in women with hemostatic disorders. Providers should consider this option for women with hemostatic disorders because it is safe and simple to use.