It’s a girl thing for sure. I was sitting on my toadstool today reflecting that it’s definitely a ladies day today on the Lifestyle Elf. Heavy periods – what a drag. Only us girls really know how draining and painful they can be. They have a clinical term too, thank goodness they are taken seriously, it’s ‘menorrhagia’.
In the past medication has been recommended as the first line of treatment for women who suffer from this condition. Medication, such as tranexamic acid, mefanamic acid, combined oestrogen and progesterone or progesterone only, have been widely used. Large numbers of women ranging from 25-50 years are afflicted and account for 20% of gynaecological referrals in the UK.
Recent research has shown, however, that a different, very successful treatment option is available. It is the levonorgestrel-releasing intrauterine system (LNG-IUS), a small plastic device inserted into your womb, which slowly releases a hormone called progesterone. It prevents the lining of your womb growing quickly and is also a form of contraceptive.
The study compared the LNG-IUS system with usual medical treatment in women who presented to their primary care providers. 571 women were randomly assigned to treatment with LNG-IUS or medical treatment with tranexamic acid, mefenamic acid, combined oestrogen-progesterone, or progesterone alone. The primary outcome measured was the patient reported score on the Menorrhagia Multi-Attribute Scale (MMAS) (ranging from 0 to 100, with lower scores indicating greater severity). All participants were assessed over a two-year period and secondary outcomes included general quality of life, sexual activity scores and surgical intervention. This is what they found:
- MMAS scores improved from baseline to 6months in both the LNG-IUS group and the usual treatment group
- The improvements were maintained over a 2-year period but were significantly greater in the LNG-IUS group than in the usual treatment group
- Improvements in all areas such as practical difficulties, social life, family life, work and daily routine, psychological well being and physical health were significantly greater in the LNG-IUS than in the usual treatment group
- At 2 years more of the women were using the LNG-UIS system than the usual medical treatment
- 49% of other trial participants switched to LNG-IUS citing, ‘lack of effectiveness’ as the reason for stopping other treatments
The authors concluded:
We hope our results are positive news for women and their GP’s. This trial tells us not only that treatments can be effective, but also what to choose, bearing in mind a women’s preferences for having a contraceptive IUD inserted or not… Heavy menstrual bleeding can be very debilitating but we know many do not seek help. We need to make women more aware beneficial treatments are available, and to offer options such as LNG-IUS more often.
Knowledge is power. Don’t suffer in silence lady friends.
J Gupta, M.D., JK M.D., L Middleton, H Pattison, R Gray,and J Daniels, Evonorgestrel Intrauterine System versus Medical Therapy for Menorrhagia N Engl J Med 2013; 368:128-137January 10, 2013 DOI: 10.1056/NEJMoa1204724