Management of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection

Menorrhagia is the presenting symptom among the majority of women who undergo hysterectomy. The levonorgestrel intrauterine system (LNG-IUS) is highly effective in reducing menstrual bleeding. The aim of this randomized study was to compare the effect of endometrial resection (ER) as a surgical modality and the LNG-IUS as a hormonal modality for treating menorrhagia. This is a therapeutic, phase III randomized study that included 60 premenopausal women with excessive uterine bleeding. The patients were randomly allocated to two treatment groups - LNG-IUS or endometrial resection (ER). Uterine bleeding was quantified by the pictorial blood loss assessment score (PBAC). The degree of disturbance caused by menstrual bleeding on general well-being, work performance, physical activity and sexual activity was assessed using a visual analogue scale at screening. Initial evaluation was followed by reassessment at 6 months, and at 12 months or at discontinuation. Both groups were matched for age, duration of flow and uterine characteristics. In the LNG-IUS group, four patients discontinued treatment and, ultimately, treatment success was 77%. In the ER Group, all operations were uneventful. A significant reduction in the amount of blood loss monthly was achieved in 83% of the cases, and there was a significant improvement in the quality of life of the patients in both study groups. The difference between the two groups was not statistically significant (p=0.747). The placement of LNG-IUS has a dramatic effect in lowering bleeding intensity in menorrhagic patients, with the advantage of reversibility, and mild adverse events. It may be the first-line treatment in younger women with menorrhagia.