Objective To determine whether the levonorgestrel-releasing intrauterine de
vice (LNG-IUS). licensed at present for contraceptive use, may reduce menst
rual blood loss with few side effects. If effective, surgery could be avoid
ed with consequent resource savings.
Methods A systematic review addressing the effectiveness and cost effective
ness of the LNG-IUS for menorrhagia was undertaken.
Results Five controlled trials and five case series were found which measur
ed menstrual blood loss. Nine studies recorded statistically significant av
erage menstrual blood loss reductions with LNG-IUS (range 74%-97%). Another
showed reduction in menstrual disturbance score. The LNG-IUS was mere effe
ctive than tranexamic acid, but slightly less effective than endometrial re
section at reducing menstrual blued loss, In one study, 64% of women cancel
led surgery at six months, compared with 14% of control group women. In ano
ther, 82% were taken off surgical waiting lists at one year. No cost effect
iveness studies were found.
Discussion Small studies of moderate quality indicate the LNG-IUS is an eff
ective treatment fur menorrhagia. Costs may be less than for tranexamic aci
d in primary and secondary care. Although its use may reduce surgical waiti
ng lists, cost effectiveness assessment requires longer follow up.
Conclusion Effectiveness and cost effectiveness relative to other treatment
s and the effect on surgical waiting lists can only be established in large
r trials measuring patient-centred outcomes in women with menorrhagia.