IUD for menorrhagia improved quality of life more than medical therapy

A levonorgestrel intrauterine device (IUD) improved quality of life more for women with menorrhagia than usual medical treatments did, a recent study found.

The trial assigned 571 British women who presented to primary care with menorrhagia to treatment with the levonorgestrel IUD or one or more medical therapies (including tranexamic acid, mefenamic acid, combined estrogen-progestogen or progesterone alone). The primary outcome was the patients' change in score on the Menorrhagia Multi-Attribute Scale (MMAS), which ranges from 0 to 100 and includes domains of practical difficulties, social life, family life, work and daily routines, psychological well-being and physical health. The study was published in the Jan. 10 New England Journal of Medicine.

After six months, women in the IUD group and the usual treatment group both showed significantly greater improvements in MMAS scores (mean increase, 32.7 points and 21.4 points, respectively; P<0.001 for both comparisons). The patients were followed for two years, and the greater benefit seen in the IUD group was maintained (mean between-group difference, 13.4 points; 95% CI, 9.9 to 16.9 points). The IUD group had bigger improvements in all of the MMAS domains and seven of eight studied quality-of-life domains. A higher percentage also kept the device for two years compared with the percentage of those in the usual treatment group who continued treatment for two years (64% vs. 38%), although researchers noted this could have related to the need for a medical visit to discontinue use of an IUD. The groups did not differ significantly in surgical intervention rates, sexual activity scores or serious adverse events.

Study authors concluded that the IUD was more effective than usual medical treatment in reducing the impact of heavy menstrual bleeding on patients' quality of life. Most previous trials have been smaller and used the reduction of menstrual blood lost as an outcome. The outcomes used in this study—the MMAS, quality-of-life measures, and sexual activity scores—may be more relevant to patients. The authors did note that a subgroup analysis showed that the IUD was relatively less beneficial in women with a body mass index below 25 kg/m² than in heavier ones, perhaps because medical treatments have greater efficacy for them.

An accompanying editorial pointed out that the medical treatments most commonly used in the study (tranexamic acid, mefenamic acid or both) are rarely used in the U.S. Still, the study adds to evidence that the IUD is superior to medical treatments for menorrhagia. The success of the study's primary care approach also suggests that women could benefit from more involvement of generalist physicians in treatment of this condition. More training in IUD insertion and FDA approval of the levonorgestrel IUD for heavy bleeding (rather than just contraception) may be appropriate, the editorial concluded.