IUD May Be Best for Heavy Menstrual Bleeding
By Salynn Boyles
Reviewed by Laura J. Martin, MD
Jan. 9, 2013 -- Heavy menstrual bleeding is a rarely discussed but remarkably common condition that affects about 1 in 4 women.
For many, monthly periods are much more than a minor annoyance. They stop life in its tracks for days each month.
Oral contraceptives and progestin hormone pills are commonly prescribed medical treatments for heavy periods in the U.S., but they aren't always effective for many women.
Now a landmark study from Europe, published in the New England Journal of Medicine, concludes that an IUD that releases progestin may be a more effective therapy.
IUD Worked Better Than Pill
The Mirena IUD implantable contraceptive was found to be superior to oral contraceptives and non-hormonal drugs approved for the treatment of heavy menstrual bleeding in reducing the condition's effect on quality of life.
The IUD is widely used in Europe to treat heavy menstrual bleeding, but it is not used as much in the U.S.
OBGYN professor Eve Espey, MD, of the University of New Mexico, says this is partly due to a bias toward surgical treatments in the U.S. and partly due to what she calls a "hangover" from negative feelings about IUDs dating back to the early 1970s.
That was when as many as 300,000 women who used an IUD known as the Dalkon Shield filed lawsuits claiming to have been injured by the device. The most common complaint was pelvic infection.
"The Dalkon Shield has given all IUDs a bad name for almost 40 years, but modern IUDs are really very safe," she says.
Quality of Life Better With IUD
The study included 571 women with heavy periods followed for two years during treatment with either the Mirena IUD, oral hormone therapy, or the non-hormonal anti-bleeding drugs tranexamic acid and mefenamic acid.
Women who used the Mirena IUD reported greater improvement in quality of life, including their social routines, work-day routines, family life, and sex.
After two years, 64% of the women in the IUD group were still using the treatment vs. 38% of the women in the group using other treatments.
Researcher Janesh Gupta, MD, of the University of Birmingham in the U.K., says the study shows that the Mirena IUD is the clear treatment for women who want to preserve their fertility.
"Around 25% of women have very heavy periods at some point in their reproductive lives," Gupta says. "This is a massive problem and this treatment is a safe and very effective option for a large percentage of women."
He says pelvic infection is not a major concern, as long as the woman is screened for infection before the IUD is fitted.
Study May Be a 'Game Changer'
Cleveland Clinic gynecologic surgeon Linda Bradley, MD, has been using the Mirena IUD to treat patients with heavy periods for many years.
She says the study has the potential to be a game changer if it brings the treatment to the attention of more women with heavy menstrual bleeding and their doctors.
Bradley is vice chair of the Obstetrics, Gynecology, and Women's Health Institute at the Cleveland Clinic as well as the director of The Fibroid and Menstrual Disorders Center and Hysteroscopic Services.
"Women with this condition will embrace this treatment if they know about it," she says. "I have used it for years, and my patients love it."
Espey agrees. She says a majority of patients that she treats with the IUD have significant improvement in their heavy bleeding.
SOURCES: Gupta, J. New England Journal of Medicine, Jan. 10, 2013. Janesh Gupta, MD, School of Clinical and Experimental Medicine, University of Birmingham, U.K. Eve Espey, MD, MPH, professor of OBGYN, University of New Mexico, Albuquerque, N.M. Linda Bradley, MD, director of hysteroscopic services, Department of OBGYN, Cleveland Clinic Center for Menstrual Disorders and Fibroids.
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