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The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review
journal contribution
posted on 2001-01-01, 00:00 authored by A Stewart, C Cummins, Lisa GoldLisa Gold, R Jordan, W PhillipsObjective: To determine whether the levonorgestrel-releasing intrauterine device (LNG-IUS), licensed at present for contraceptive use, may reduce menstrual blood loss with few side effects. If effective, surgery could be avoided with consequent resource savings. Methods: A systematic review addressing the effectiveness and cost effectiveness of the LNG-IUS for menorrhagia was undertaken. Results: Five controlled trials and five case series were found which measured menstrual blood loss. Nine studies recorded statistically significant average menstrual blood loss reductions with LNG-IUS (range 74%–97%). Another showed reduction in menstrual disturbance score. The LNG-IUS was more effective than tranexamic acid, but slightly less effective than endometrial resection at reducing menstrual blood loss. In one study, 64% of women cancelled surgery at six months, compared with 14% of control group women. In another, 82% were taken off surgical waiting lists at one year. No cost effectiveness studies were found. Discussion: Small studies of moderate quality indicate the LNG-IUS is an effective treatment for menorrhagia. Costs may be less than for tranexamic acid in primary and secondary care. Although its use may reduce surgical waiting lists, cost effectiveness assessment requires longer follow up. Conclusion: Effectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient-centred outcomes in women with menorrhagia.
History
Journal
BJOG: an international journal of obstetrics & gynaecologyVolume
108Issue
1Pagination
74 - 86Publisher
Wiley-Blackwell Publishing Ltd.Location
Bognor Regis, EnglandPublisher DOI
ISSN
0140-7686eISSN
1471-0528Language
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
2001, British Journal of Obstetrics and GynaecologyUsage metrics
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