Table 9Primary outcomes of LNG-IUS for abnormal cyclic uterine bleeding

Author, Year
Country
Quality
Comparison Groups (n)Key Outcomes
Kaunitz et al., 201060
United States, Canada, Brazil
Fair
G1: LNG-IUS (82)
G2: MPA,10 mg daily for 10 days of each cycle (83)
  • Median reduction in MBL (alkaline hematin) was −128.7 ml in G1 compared with −17.8 ml in G2 after 6 cycles (p<0.001).
  • Higher proportion of women with successful treatment (defined as MBL<80 ml and 50% or greater reduction in MBL from baseline) in G1 (84.8%) compared with G2 (22.2%) (p<0.001).
Irvine et al., 199864
United Kingdom
Fair
G1: LNG-IUS (22)
G2: Norethisterone, 5 mg 3 times daily on cycle day 5 to 26 (22)
  • MBL decreased significantly in both groups after 3 cycles (94% reduction for G1 and 87% reduction for G2).
  • More women in G1 (76%) wished to continue treatment after 3 months as compared with G2 (22%).
Shaaban et al., 201159
Egypt
Poor
G1: LNG-IUS (56)
G2: Low-dose COC, 30 mcg ethinyl estradiol and 150 mcg levonorgestrel (56)
  • MBL assessed by alkaline hematin method significantly (p<0.001) decreased in both groups from baseline.
  • Greater reduction in MBL measured by alkaline hematin method at 12 months in G1 (87.4 ± 11.3%) compared with G2 (34.9 ± 76.9%) (p=0.01).
  • PBLAC scores decreased more in G1 (86.6 ± 17.0%) compared with G2 (2.5 ± 93.2%) at 12 months (p<0.001).
  • Women in G1 had significant improvements in ferritin and hemoglobin at 12 months.
  • Fewer bleeding days per year in G1 (34.5 ± 12.0) compared with G2 (65.1 ± 15.3) (p<0.001).
Endrikat et al., 200961
Canada
Poor
G1: LNG-IUS (20)
G2: COC, 1 mg norethindrone acetate and 20 mcg ethinyl estradiol (19)
  • PBLAC score decreased significantly (p<0.001) in both groups at 12 months.
  • The MBL median score decreased more in G1 (from 228 to 13, −83% mean change) compared with G2 (from 290 to 72, mean change −68%) (p=0.002).
  • Proportion of women with successful treatment (defined as MBL score<100 at 12 months) higher in G1 (80%) compared with G2 (37%) (p<0.009).
  • Mean hemoglobin levels increased in both groups from baseline (p<0.001).
Kucuk and Ertan, 200862
Turkey
Poor
G1: LNG-IUS (44)
G2: DMPA, single shot (44)
G3: MPA, 5 mg daily (44)
  • More women in G1 (86%) with successful treatment compared with G2 (75%) or G3 (68%).
  • PBLAC scores, days of menstrual bleeding, and hemoglobin improved in all 3 groups from baseline.
  • Mean MBL scores at 6 months were lower in G1 (77) compared with G2 (146) and G3 (154) (p<0.01).
Reid and Virtanen-Kari, 200563
United Kingdom
Poor
G1: LNG-IUS (25)
G2: Mefenamic acid, 500 mg 3 times per day for first 4 days of cycle (26)
  • MBL significantly reduced in both groups from baseline.
  • After 6 months median MBL was 5 ml in G1 compared with 100 ml in G2 (p<0.001).
Lahteenmaki et al., 199865
Finland
Poor
G1: LNG-IUS (28)
G2: Usual care (28)
  • Proportion of women cancelling hysterectomy was 64% in G1 vs. 14.3% in G2 (p<0.001).

COC = combined oral contraceptive; DMPA = depot medroxyprogesterone; LNG-IUS = levonorgestrel-releasing intrauterine system; MBL = menstrual blood loss; MPA = medroxyprogesterone; PBLAC = pictorial blood loss assessment chart

From: Results

Cover of Primary Care Management of Abnormal Uterine Bleeding
Primary Care Management of Abnormal Uterine Bleeding [Internet].
Comparative Effectiveness Reviews, No. 96.
Hartmann KE, Jerome RN, Lindegren ML, et al.

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