The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review.
OBJECTIVE
To determine whether the levonorgestrel-releasing intrauterine device (LNG-IUS), licensed at present for contraceptive use, may reduce menstrual blood loss with few side effects. If effective, surgery could be avoided with consequent resource savings.


METHODS
A systematic review addressing the effectiveness and cost effectiveness of the LNG-IUS for menorrhagia was undertaken.


RESULTS
Five controlled trials and five case series were found which measured menstrual blood loss. Nine studies recorded statistically significant average menstrual blood loss reductions with LNG-IUS (range 74%-97%). Another showed reduction in menstrual disturbance score. The LNG-IUS was more effective than tranexamic acid, but slightly less effective than endometrial resection at reducing menstrual blood loss. In one study, 64% of women cancelled surgery at six months, compared with 14% of control group women. In another, 82% were taken off surgical waiting lists at one year. No cost effectiveness studies were found.


CONCLUSIONS
Small studies of moderate quality indicate the LNG-IUS is an effective treatment for menorrhagia. Costs may be less than for tranexamic acid in primary and secondary care. Although its use may reduce surgical waiting lists, cost effectiveness assessment requires longer follow up.


CONCLUSIONS
Effectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient-centred outcomes in women with menorrhagia.
Stewart
A
A
Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, UK.
Cummins
C
C
Gold
L
L
Jordan
R
R
Phillips
W
W
D000328:Adult; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D008595:Menorrhagia / Q000188:drug therapy* / Q000191:economics; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D016912:Levonorgestrel