A prospective study on efficacy of levonorgestrel intrauterine system in abnormal uterine bleeding of perimenopausal age group at tertiary care centre

Abstract

Background: In women with heavy menstrual bleeding who presented to primary care providers, the LNG- IUS was more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life. Aim: This study was conducted to evaluate the efficacy, acceptability and side effects of LNG-IUS in perimenopausal women with abnormal uterine bleeding. Methodology: 50 women with benign cause of abnormal uterine bleeding in perimenopausal age group were selected from 1st December 2017 to 15th October 2018 and followed till 15thOctober 2019 at Government maternity hospital , Osmania medical college, Hyderabad which is a tertiary care centre . The hospital health board ethics committee approved the trial protocol. Potential recruits were drawn from outpatient department of this hospital. Results: Objectively measured menstrual blood loss assessed by PBAC score was significantly reduced after the treatment compared with pre-treatment scores. At 1 month PBAC scores were slightly variable from pre treatment with significance level of p value <0.05.At 3,6 ,and 12 months, PBAC scores were significantly lower in women treated with the LNG-IUS (p value <0.001 ).By the end of 3 months percentage of patients with dysmenorrhea had fallen from 60 % pre treatment to 25% ,and to 13 % by 6 months and 4.5% by 12 months showing a significant improvement in dysmenorrhea. There was irregular spotting in patients after insertion of LNG -IUS because of endometrial atrophy and decreased estrogen support. Initially at 3 months it was 43.7%, gradually fallen to 28.8% by 6 months and 13.6% by 12 months. By 3 months and 12 months post-treatment, there was a significant reduction in the number of days of heavy bleeding ( p value <0.001 )compared with pre- treatment. Treatment failures were assessed at 1, 3, 6 and 12 months. There are 5 treatment failures included the following: by 15 days , one LNG-IUS had been removed due to pain not relieved with analgesics; by 3 months there was one expulsion of LNG-IUS ; by 6 months there are 3 treatment failures , one woman had expulsion of LNG-IUS , 2 women had removed LNG-IUS due to persisting menorrhagia and unscheduled bleeding, by 12 months there were no treatment failures. Quality of life was assessed using the SF-36 at pre treatment and 12 months post insertion. The results suggest that there was a significant increase in quality of life from pre treatment to 12 months post insertion of LNG-IUS with p value <0.001. Conclusion: LNG-IUS can be choice of treatment for entire reproductive years and it also helps in smooth transition to menopause. So, hysterectomy should be avoided for inappropriate reasons and femininity must be preserved.