Hormone releasing intrauterine system should be used more widely in primary care for menorrhagia, study concludes

BMJ 2013; 346 doi: (Published 09 January 2013) Cite this as: BMJ 2013;346:f100
  1. Zosia Kmietowicz
  1. 1BMJ

Women with menorrhagia reported more improvement in bleeding and quality of life with the levonorgestrel releasing intrauterine system than with other treatments available in primary care, a two year study in England has found.1

Women fitted with the levonorgestrel releasing intrauterine system (also known as LNG-IUS or Mirena) were also more likely to stick with treatment, found the study, called the Effectiveness and Cost-Effectiveness of Levonorgestrel-Containing Intrauterine System in Primary Care against Standard Treatment for Menorrhagia (ECLIPSE) study.

Researchers from the Universities of Birmingham and Nottingham randomised 571 women to treatment with either LNG-IUS or another standard medical treatment, such as tranexamic acid, mefenamic acid, combined oestrogen and progestogen, or progestogen only.

After six months all patients reported improved outcomes, but women treated with the LNG-IUS improved significantly more than did other women. On the menorrhagia multi-attribute scale women with the LNG-IUS scored a mean increase of 32.7 points, whereas among other women the mean increase was 21.4 points. The difference between the two groups remained significant after two years (mean difference over two years 13.4 points (95% confidence interval 9.9 to 16.9), and improvements were shown in all the domains measured by the scale, including social life, work and daily routine, and psychological wellbeing.

After two years nearly two thirds (64%) of the women fitted with the LNG-IUS were still using it, compared with just over a third (38%) of women using the other treatments. At the end of the trial about half the women who were receiving the usual treatments switched to LNG-IUS, citing “lack of effectiveness” as the reason for stopping the other treatments.

One of the study’s authors. Joe Kai, a GP and professor of primary care at the University of Nottingham, said, “We hope our results are very positive news for women and their GPs. This trial tells us not only that treatments can be effective but also what to choose, bearing in mind a woman’s preferences for having a contraceptive IUS inserted or not.

“Heavy menstrual bleeding can be very debilitating, but we know that many do not seek help. We need to make women more aware that beneficial treatments are available and to offer options such as LNG-IUS more often.”

Another author, Janesh Gupta, professor of obstetrics and gynaecology at the University of Birmingham and who is based at Birmingham Women’s Hospital, said, “While the interventions studied in this trial represent options available in primary care settings in the UK, insertion of IUDs is not part of primary care in all healthcare settings and in some circumstances requires gynaecologist consultation. This trial should encourage the use of IUDs in primary care.”


Cite this as: BMJ 2013;346:f100