Levonorgestrel IUD reduces blood loss in severe heavy menstrual bleeding
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Key takeaways:
- Users with heavy menstrual bleeding had a 93.3% decrease in blood loss of during the third and 97.6% during the sixth cycle with use of a levonorgestrel IUD.
- BMI and parity did not affect efficacy.
Levonorgestrel 52 mg IUD reduces blood loss by more than 90% over 6 months among women with severe heavy menstrual bleeding, according to results of a prospective trial published in Obstetrics & Gynecology.
“Patients with severe heavy menstrual bleeding unrelated to uterine factors or underlying medical issues have a very rapid decline in flow after levonorgestrel 52 mg IUD placement, and this effect is seen regardless of obesity status or parity,” Mitchell D. Creinin, MD, professor in the department of obstetrics and gynecology and director of the Complex Family Planning Fellowship at the University of California, Davis Health, Sacramento, told Healio.
Creinin and colleagues evaluated data from 105 participants aged 18 to 50 years with heavy menstrual bleeding not caused by pelvic or systemic pathology at 29 U.S. centers. All participants had up to three screening cycles with menstrual product collection for alkaline hematin blood loss measurements. In addition, all participants had two menses with blood loss of 80 mL or more. Researchers placed the IUD and followed participants for up to six 28-day menstrual cycles collecting used menstrual products during the third and sixth cycle for blood loss measurements.
The primary outcome was median absolute change in blood loss. Secondary outcomes were treatment success defined as the proportion of participants with a final measured blood loss less than 80 mL and at least 50% reduction from baseline.
Overall, 44.8% of participants had a BMI of 30 kg/m2 or higher, and 27.6% of participants were nulliparous. At baseline, median blood loss among participants was 143 mL. Of the 89 participants with at least one evaluable follow-up, 86 experienced a decrease in median absolute blood loss of 93.3% at the third menstrual cycle, and 81 experienced a decrease in median absolute blood loss of 97.6% at the sixth cycle.
At the sixth menstrual cycle, participants with and without obesity experienced similar median decreases in blood loss (97.5% vs. 97.6%, respectively). Also, participants who were nulliparous and parous experienced similar median decreases in blood loss at the sixth cycle (97% vs. 98.1%, respectively).
Regarding treatment success, 81.8% of participants experienced success, according to the researchers. The most common adverse events that led to discontinuation were bleeding or cramping among 5.7% of participants and expulsion among 4.8%.
“Expulsion is much higher in patients that have heavy menstrual bleeding, especially if they are obese and parous, as compared to levonorgestrel 52 mg IUD use in a contracepting population,” Creinin said. “We have known this for years, but that fact is often under the radar.”
According to Creinin, moving forward, research is needed on how long after IUD removal does the bleeding return to its heavy level, as it is expected to be a rapid return, but there is no research to demonstrate such outcome.
For more information:
Mitchell D. Creinin, MD, can be reached at mdcreinin@ucdavis.edu.