Author(s): Kunjamma Roy1, Ajay Kumar2
BACKGROUND Abnormal uterine bleeding is one of the most frequent reasons for gynaecological consultation, occurring in approximately 30% of women of reproductive age. Menorrhagia by definition implies a menstrual blood loss equal to or greater than 80 mL. Many women seek consultation for bleeding episodes of less than this amount because of the stress associated with it. Most frequently used medications are combinations of prostaglandin synthetase inhibitors and antifibrinolytic drugs, nonsteroidal anti-inflammatory drugs, oral progesterone like Norethisterone or medroxyprogesterone acetate and combined oral contraceptives. The usual treatment for women with menorrhagia not desiring further pregnancies and those not responding to medical managements is either hysterectomy or endometrial ablation. Endometrial ablation less commonly performed due to low success rate. Levonorgestrel intrauterine system (LNG-IUS) is a new modality in the treatment of AUB. The objective of this study is to evaluate the use of Levonorgestrel intrauterine system as a treatment for women with menorrhagia.
MATERIALS AND METHODS This is a prospective interventional comparative study conducted on women with abnormal uterine bleeding. The duration of study was from March 2012 to October 2013. The respondents include those outpatients attending Gynaecology Department of Government Medical College, Kottayam with menorrhagia. The samples size was 50 of which 25 were in experimental groups and remaining 25 in control group. Experimental group were given LNG IUS for menorrhagia and the remaining 25 patients were given oral progestins for heavy menstrual bleeding. In order to make a comparison of the impact of the two different kinds of interventions, the Hb level as well as the amount of blood loss were systematically estimated at frequent intervals. Accordingly, these measurements were carried for the said both groups at the commencement of research study and thereafter at an interval of 1 month, 3 months and 6 months.
RESULTS There is a statistical improvement in the Hb level from the 3rd month of insertion of LNG-IUS (p >0.005). At the commencement of study, the mean score of Hb among experimental group was 10.52 g% as against 10.16 g% among the control group. While at 1 month, it was found to be 10.98 g% as against 10.34 g% among the control group. At the third month, it was 11.53 g% as against 10.58 g% and at 6 months, it was 11.76 g% as against 10.87 g%. The amount of blood loss was also found to be decreased in the IUS group. The mean amount of blood loss at the commencement of the study in the experimental group and control group were 117 mL as against 114.4 mL, while at 1 month it was 100.8 mL as against 102.24 mL in control group. After 3 months, the blood loss was 78.2 mL as against 93 mL in control group. At 6 months, it was 62.27 mL as against 83.08 mL.
CONCLUSION The use of Levonorgestrel releasing intrauterine system (LNG IUS) is found to be effective in controlling menstrual blood loss and thus achieving higher Hb levels.