From the Guidelines
For women experiencing heavy bleeding, the levonorgestrel-releasing intrauterine device is the safest and most effective contraceptive option, reducing menstrual blood loss by 40-50% and inducing amenorrhoea in a significant proportion of users. This is based on the evidence from the European Society of Cardiology 1, which highlights the benefits of this device in women with heavy menstrual bleeding.
Key Benefits of Levonorgestrel-Releasing Intrauterine Device
- Reduces menstrual blood loss by 40-50%
- Induces amenorrhoea in a significant proportion of users
- Safe for use in women with cyanotic congenital heart disease and pulmonary vascular disease
Important Considerations
- 5% of patients may experience vasovagal reactions at the time of implant
- Should be implanted in a hospital environment for women with highly complex heart disease
- Contraindicated in cyanotic women with haematocrit levels >55% due to increased risk of excessive menstrual bleeding Other options, such as combined hormonal contraceptives, progestin-only pills, and the contraceptive implant, may also be effective in reducing heavy bleeding, but the levonorgestrel-releasing intrauterine device is the most effective and safest option, as supported by the evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Heavy Menstrual Bleeding Treatment Options
The following are some treatment options for heavy menstrual bleeding:
- Levonorgestrel-releasing intrauterine system (LNG-IUS)
- Combined oral contraceptives
- Tranexamic acid
- Oral mefenamic acid
- Endometrial ablation
- Hysterectomy
Effectiveness of LNG-IUS
Studies have shown that the LNG-IUS is an effective treatment option for heavy menstrual bleeding, including for women with underlying uterine pathology or bleeding disorders 2, 3, 4. The LNG-IUS has been found to reduce menstrual blood loss to a greater extent than other medical therapies, such as combined oral contraceptives and tranexamic acid 2.
Comparison with Other Treatments
A randomized trial comparing the 52-mg levonorgestrel system with combination oral contraceptives for treatment of heavy menstrual bleeding found that both treatments were effective in improving bleeding-related quality of life, with no significant difference between the two treatments at 6 and 12 months 5. Another study found that the LNG-IUS was superior to conventional medical treatment in reducing menstrual blood loss and improving quality of life 3.
Long-Term Efficacy
Long-term follow-up studies have shown that the LNG-IUS is an effective long-term treatment for heavy menstrual bleeding, with significant improvements in menstrual blood loss, hemoglobin concentrations, and quality of life 4, 6. A long-term randomised pragmatic trial in primary care found that commencing the LNG-IUS or usual medical treatments for women presenting with heavy menstrual bleeding resulted in significant improvements in symptom relief, with only modest need for surgery 6.