From the Guidelines
For managing menorrhagia, the levonorgestrel-releasing intrauterine system (Mirena) is the most effective birth control option, reducing menstrual blood loss by up to 90% after several months of use. This option is preferred due to its high efficacy in reducing menstrual bleeding and its convenience as a long-term contraceptive solution, providing contraception for up to 7 years 1. The device works by releasing a small amount of progestin directly into the uterus, which thins the uterine lining and reduces bleeding while also preventing pregnancy.
Other effective options for managing menorrhagia include combined hormonal contraceptives (pills, patches, or rings), which can reduce bleeding by about 40-50% by regulating hormonal fluctuations and thinning the endometrium 1. However, these methods may have side effects such as nausea, breast tenderness, or headaches initially, and their effectiveness in reducing menstrual bleeding is generally lower compared to the levonorgestrel-releasing intrauterine system.
Key considerations for the use of these birth control options include:
- The need for a pelvic exam and possibly an ultrasound to rule out underlying conditions before starting treatment
- Potential side effects, such as irregular spotting during the first 3-6 months with hormonal IUDs
- The importance of correct use and timing to minimize unscheduled spotting or bleeding with combined hormonal contraceptives
- The potential for hormone-free intervals to improve bleeding patterns with extended or continuous combined hormonal contraceptives 1
Overall, the choice of birth control option for managing menorrhagia should be based on individual patient needs and medical history, with consideration of the potential benefits and risks of each option. The levonorgestrel-releasing intrauterine system is generally the preferred option due to its high efficacy and convenience, but other options may be suitable for patients with specific needs or preferences.
From the Research
Best Birth Control Options for Menorrhagia
The following birth control options are effective for managing menorrhagia:
- Levonorgestrel-releasing intrauterine system (LNG-IUS) 2, 3, 4, 5
- Combined oral contraceptives (COC) 2, 6, 3, 5
Comparison of LNG-IUS and COC
Studies have compared the efficacy of LNG-IUS and COC in reducing menstrual blood loss:
- A Canadian study found that LNG-IUS decreased menstrual blood loss more significantly than COC 2
- A systematic review and meta-analysis found that LNG-IUS was superior to conventional medical treatment, including COC, in reducing menstrual blood loss 4
- A randomized trial found that LNG-IUS and COC were both effective in improving bleeding-related quality of life, with no significant difference between the two at 6 and 12 months 5
Effectiveness of LNG-IUS
The LNG-IUS has been shown to be effective in reducing menstrual blood loss and improving quality of life:
- A study found that LNG-IUS reduced menstrual blood loss by 90.9% compared to 13.4% with COC 3
- A systematic review and meta-analysis found that LNG-IUS was associated with a lower rate of discontinuation and fewer treatment failures compared to conventional medical treatment 4
Effectiveness of COC
COC has also been shown to be effective in reducing menstrual blood loss and improving quality of life: