Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding.
OBJECTIVE
Menorrhagia is a frequent reason for women to seek medical care and an increasingly common health problem. The levonorgestrel-releasing intrauterine system is an effective medical treatment for menorrhagia. Emerging clinical and research evidence suggests that this new treatment modality has major health benefits.


RESULTS
The levonorgestrel-releasing intrauterine system is a cost-effective treatment modality for menorrhagia. The quality of life improves significantly which is comparable to that gained with hysterectomy. The costs are about half those of hysterectomy after 5 years of follow-up. Unscheduled breakthrough bleeding is the most common side effect of the treatment. There are different new theories about the mechanism underlying this problem. Women with endometriosis or fibroids also benefit from this treatment.


CONCLUSIONS
Because menorrhagia is often a reason for seeking medical attention, it is important to consider the outcomes and costs to provide the most appropriate care. The levonorgestrel-releasing intrauterine system improves health-related quality of life significantly at relatively low cost. It is the most effective medical treatment for menorrhagia and comparable to surgical interventions. The system is not associated with serious complications. Although not all women are successfully treated, about 60% avoid hysterectomy and are satisfied with the treatment. Thus, the levonorgestrel-releasing intrauterine system should be the first line of treatment for heavy menstrual bleeding.
Hurskainen
Ritva
R
Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, PL 140, 0029 HUS, Helsinki, Finland. ritva.hurskainen@hus.fi
Paavonen
Jorma
J
D003271:Contraceptive Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D004715:Endometriosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D007889:Leiomyoma / Q000188:drug therapy; D016912:Levonorgestrel / Q000009:adverse effects / Q000627:therapeutic use*; D008595:Menorrhagia / Q000188:drug therapy*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel