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21-01-2013 | General practice | Article

IUS first choice for heavy periods


NEJM 2013: 368: 128–137

medwireNews: Research published in the New England Journal of Medicine shows that the levonorgestrel intrauterine system (IUS; brand name Mirena) is more effective than standard pharmacological therapies for the treatment of heavy menstrual bleeding.

Furthermore the study, which reports on the largest trial of the treatment to date, showed that the effects were maintained over 2 years. The findings support the NICE/RCOG recommendation to use the IUS first-line for heavy menstrual bleeding - guidance that was first issued in 2007 on the basis of expert opinion but, until now, has lacked robust long-term evidence.

The UK-based study included 571 women who had presented to their GP with at least three cycles of heavy bleeding. Half of the women were randomly assigned to be fitted with the IUS, while the other half received mefenamic acid and tranexamic acid, either singly or in combination, as well as oral contraception if required.

Overall scores on the Menorrhagia Multi-Attribute Scale (MMAS), which measures the impact of heavy bleeding on daily life, improved at 6 months, 12 months and 2 years compared with baseline in both groups. However, the scores of patients in the IUS group improved significantly more, with an average 13.4-point difference out of 100 between the groups over 2 years.

"A 13.4-point difference represents a change in two or three MMAS domains: from being substantially to minimally affected by menorrhagia or from being minimally affected to being unaffected," say Dr Jane Daniels, of the University of Birmingham, and colleagues.

The team also found that after 2 years, women in the IUS group were almost twice as likely to still be receiving their assigned treatment as women in the standard treatment group, at 64% compared with 38%.

medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Kirsty Oswald