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Intrauterine device, oral treatments improve heavy menstrual bleeding

Women who underwent treatment prescribed by a general practitioner for heavy menstrual bleeding experienced significant symptom improvement with little need for surgery, according to research published in the British Journal of General Practice.

“This is very encouraging news,” Joe Kai, MD, professor of primary care, School of Medicine, University of Nottingham, England, said in a press release. “This trial shows women can be helped considerably by treatments from their [general practitioner (GP)], with most avoiding hospital procedures up to [5] years later.”

Kai and colleagues randomly assigned 571 women aged 25 to 50 years with heavy menstrual bleeding to receive either a levonorgestrel-releasing intrauterine system (LNG-IUS), such as the Mirena coil, or usual medical treatments, such as tranexamic/mefenamic acid, combined estrogen/progestogen or progesterone alone. Patients were asked to record the treatments’ effect on work and family life, physical and psychological health, social life and practical difficulties using the Menorrhagia Multi-Attribute Scale (MMAS) for 5 years. Secondary outcomes included safety, sexual activity, general quality of life, and surgical intervention (endometrial ablation/hysterectomy).

Of the initial group, 424 returned the requested information. Researchers wrote MMAS scores went from an average at baseline of approximately 40, meaning a patient’s life was “substantially affected” to greater than 80, or “significantly improved.” There was no significant difference between patients who received the LNG-IUS and those who received an oral treatment. Further, researchers wrote, the 5-year surgery-free survival rate was 80% (95% CI, 74-84) in the LNG-IUS group vs. 77% (95% CI, 71-82) in the usual treatment group. There was no significant difference in sexual activity scores or serious adverse events. The only statistically significant difference between the two groups was in general health perception, in which patients receiving LNG-IUS had better scores: (4.7, 95% CI, 0.6-8.8).

“[This study] also shows women starting with either a Mirena coil or other oral medications will have similar benefit over time,” Kai said in the release. “This is helpful for women and their GPs to know when first considering what treatments to use, taking account of individual preferences and circumstances. If women troubled by heavy menstrual bleeding do choose to see their GP, we can be confident we can help”.

Researchers wrote they plan to check in with the study’s participants in 5 more years, when approximately half will be in menopause, for additional analysis of surgical intervention and treatments. – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.