Levonorgestrel intrauterine device in the treatment of menorrhagia in Chinese women: Efficacy versus acceptability

Abstract

Ten Chinese women who had menorrhagia without organic cause and suffered from anaemia were treated with levonorgestrel intrauterine device for a total of 129 woman-months. There was a 54%, 87% and 95% reduction in menstrual blood loss at the first, third and sixth month of treatment when compared with the pretreatment cycle. These percentages of reduction were statistically significant, with p values of 0.004, 0.03 and 0.008, respectively. There was a median increase in menstrual cycle length of 12 days in nine months. Fifteen percent of the menstrual cycles were longer than 60 days. The total bleeding days increased by 4 days at the third menstrual cycles, but reduced to a median of 6 days at 6 months. Seventy-six percent of the menstrual bleeding was in the form of spotting. These Chinese women accepted such menstrual alterations. There was no hormonal side effects. All women preferred the device to hysterectomy. Levonorgestrel intrauterine device appeared to be an effective and acceptable treatment for menorrhagia in perimenopausal Chinese women. | Clinicians followed 10 married multiparous women aged 38-50 admitted to Queen Mary Hospital in Hong Kong for menorrhagia for 12 months to confirm the efficacy of the levonorgestrel IUD (LNG-IUD) in treating menorrhagia, to examine menstrual changes, and to determine the acceptability of LNG-IUD as a treatment for menorrhagia in Chinese women. The women served as their own controls. They had hemoglobin levels less than 11.7 gm%. Menstrual blood loss (MBL) declined significantly after LNG-IUD treatment (183 ml vs. 85.5 ml at 1 month, 24 ml at 3 months, and 10 ml at 6 months). The percent reductions were 54.35%, 86.89%, and 95%, respectively (p = 0.004, 0.031, and 0.008, respectively). The post-treatment median hemoglobin levels were higher than pretreatment levels (12.5 gm% at 6 months vs. 10.1 gm%). The median menstrual cycle length increased by 12 days in 9 months. 15% of menstrual cycles lasted longer than 60 days. Between pretreatment and the third menstrual cycle, the total median bleeding days increased by 4 days (8-12 days). At 6 months, however, they were reduced to a median of 6 days. Spotting was the predominant form of menstrual bleeding (76%). The changes in the menstrual pattern did not affect continuation. The women's chief concern was a reduction in MBL, so changes in the menstrual pattern were acceptable. No one complained of hormonal side effects (e.g., acne, weight gain, and mood changes). The women preferred the LNG-IUD to remembering when to take oral contraceptives or to undergoing hysterectomy. These findings show that perimenopausal Chinese women find the LNG-IUD to be an effective and acceptable treatment for menorrhagia.