Treating Heavy Menstrual Bleeding

Good news for women, and there are a lot of them, who suffer heavy menstrual bleeding each month: a type of IUD has been shown to help the majority of women and has very few side effects, according to a study in the New England Journal of Medicine.  And as Rick and I agree on PodMed this week, an additional benefit is the device is very effective for birth control as well.  Yay! As someone who has dealt with this problem for many, many years, I am just so happy that there's an easily employed solution to a condition that's inconvenient at best, but often much worse than that, negatively impacting quality of life in a multitude of ways. Since heavy menstrual bleeding, or menorrhagia as it's known in medical parlance, accounts for one in five visits to the gynecologist in both the US and the UK, I'm in good company.

A total of 571 women with menorrhagia were assigned to either usual medical treatment, consisting of one of four oral agents, including two formulations of oral contraceptives,  or the levonorgestrel intrauterine system (IUS).  All of the women had three or more heavy menstrual periods prior to study entry and the groups were balanced as much as practical with regard to age, BMI, whether or not they had pain in addition to the menorrhagia, and whether they required birth control in addition to bleeding control.  Assessment took place at six month intervals for 2 years. The primary outcome measure was a scale used to assess the impact of menorrhagia on six domains of daily life: social life, psychological health, practical difficulties, physical health, work and daily routine, and family life and relationships.  A secondary outcome was sexual activity.

Women in the levonorgestrel IUS group were about twice as likely as those in the medical therapy group to have continued their treatment at the two year follow-up. Lack of effectiveness was cited by 37% of those using the intrauterine device as a reason to discontinue therapy, while 53% had the same outcome with medical therapy. Side effects of therapy were the same in both groups. Finally, the levonorgestrel IUS group reported significantly greater improvements in all six areas of quality of life queried.

Seems to me that this device is a great option for women with menorrhagia.  In general insertion is a quick matter, as is removal, and it allows women to avoid some of the other treatment options such as endometrial ablation, or most definitely, hysterectomy, to deal with the problem.  It's worth mentioning that in the background material in the paper the authors state that many women overestimate the amount of blood they lose each month, with a clinical threshold of 80ml of blood lost per period defining menorrhagia, a criterion met by only about half the women who present to health care providers with this complaint.  However, most women who seek medical care do so because of the social consequences of heavy bleeding rather than concerns about bleeding volume.  Again I say, yay!

Other topics this week include MMWR's sobering look at binge drinking in women and adolescent girls, the emergence of antibiotic resistant gonorrhea in North America and vitamin D and osteroarthritis, both in JAMA.  Until next week, y'all live well.




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