Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy   Commentary: Promising results but wider recruitment needed

The treatment of dysfunctional uterine bleeding with the Mirena IUS: a survival analysis

“…Various outcome measures have been reported to indicate successful treatment with the Mirena IUS, such as the amenorrhoea rate, which varies widely from 36% [3] to 75% [1], and avoidance of surgery for menorrhagia: 67.4% [2] to 64.3% [4]. In those women who still had a Mirena IUS in our study, the amenorrhoea rate was 38% and the oligomenorrhoea rate was 72%, which compares favourably with previous studies.…”

“…This is a considerably lower initial failure rate than previously reported and it is at variance with the advice given in the product information leaflet. In a study comparing the Mirena IUS to trans-cervical resection of the endometrium (TCRE), 50% of treatment failures occurred in the initial 6 months after insertion [3] whereas a study comparing the Mirena IUS to hysterectomy found that 58% of treatment failures occurred in the initial 6 months [4] and in a prospective cohort study, the failure rate was 65% [5].…”

“…The reported oligomenorrhoea rates range from 75% to 91% [1,2], and the amenorrhoea rate in a randomised controlled trial was 36% [3]. However, the device may have to be removed prematurely for a variety of reasons in as many as 57% of users [4]. This may be due to progestogenic side effects, such as weight gain, greasy skin, acne and breast tenderness, and women may also experience pelvic pain and irregular vaginal bleeding.…”

The Management of Dysfunctional Uterine Bleeding

“…Although there was a higher rate of successful treatment in those undergoing transcervical resection or balloon ablation in four trials, rates of satisfaction and change in quality of life were similar, but women with levonorgestrel-releasing intrauterine system had a greater incidence of progestogenic side effects within a year. In two studies, 82% and 64% of women on a waiting list of hysterectomy cancelled their surgery after using levonorgestrel-releasing intrauterine system (Barrington & Bowen-Simpkins, 1997;Lähteenmaki et al, 1998). Another study comparing levonorgestrel-releasing intrauterine system with hysterectomy, revealed that there was no significant difference in quality of life scores, but the former treatment had lower costs than the latter (Hurskainen et al, 2001).…”

Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

“…Studies report reduction of blood loss in menstrual cycles up to 97%, with its maximum efficacy 1 year after insertion [24,[28][29][30][31]. The majority of women with Mirena® bleed only for 1 day or experience just spotting during their period, while 15% of them become amenorrheic [31].…”