A randomized clinical trial of a levonorgestrel-releasing intrauterine system and a low-dose combined oral contraceptive for fibroid-related menorrhagia

Objective: To compare the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) with that of a low-dose combined oral contraceptive (COC) in reducing fibroid-related menorrhagia. Methods: In this single-center, open, randomized clinical trial, 58 women with menorrhagia who desired contraception were randomized to receive a LNG-IUS or COC. The outcomes included treatment failure, defined as the need for another treatment; menstrual blood loss (MBL) by the alkaline hematin method and a pictorial assessment chart (PBAC); hemoglobin levels; and lost days. Results: Treatment failed in 6 women (23.1%) in the LNG-IUS group and 11(37.9%) in the COC group, for a hazard ratio of 0.46 (95% CI, 0.17-1.17, P=0.101). Using the alkaline hematin test, the reduction of MBL was significantly greater in the LNG-IUS group (90.9%+/- 12.8% vs 13.4%+/- 11.1%; P<0.001). Using PBAC scores, the reduction was also significantly greater in the LNG-IUS group (88.0% +/- 16.5% vs 53.5% +/- 51.2%; P=0.02). Moreover, hemoglobin levels increased from 9.7 +/- 1.9 g/dL to 11.7 +/- 1.2 g/dL (P< 0.001) and lost days decreased from 8.2 +/- 33 days to 13 +/- 1.5 days (P=0.003) in the LNG-IUS group. Conclusion: Although the rate of treatment failure was similar in both groups, the LNG-IUS was more effective in reducing MBL than the COC in women with fibroid-related menorrhagia. (C) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.