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Long-Term Treatment of Menorrhagia With Levonorgestrel Intrauterine System Versus Endometrial Resection

Ilkka Rauramo, MD, PhD^*, Iina Elo, MSc and Olav Istre, MD, PhD

From the *The Finnish Medical Society Duodecim, Helsinki, Finland; Schering Oy, Research and Development, Clinical Operations, Helsinki, Finland, and Department of Obstetrics and Gynecology, Central Hospital of Hedmark County, Hamar, Norway.

Address reprint requests to: Ilkka Rauramo, MD, The Finnish Medical Society Duodecim, PO Box 713, 00101 Helsinki, Finland; e-mail: ilkka.rauramo{at}duodecim.fi.

OBJECTIVE: The purpose of this study was to compare the long-term efficacy of the levonorgestrel intrauterine system and transcervical resection of the endometrium in the treatment of menorrhagia.

METHODS: This study was an open, randomized 3-year trial. Patients with menorrhagia were assigned randomly to either the levonorgestrel intrauterine system (n = 30) or endometrial resection (n = 29). Pictorial blood loss assessment charts were used to measure menstrual blood loss. A pictorial blood-loss assessment chart score exceeding 75 (representing menstrual blood loss 60 mL) was used to diagnosis the patient as having menorrhagia. Discontinuations and cases requiring repeat operations were evaluated.

RESULTS: Pictorial blood loss scores decreased from a baseline median of 261.5 (range, 60–1503) to 7 (range, 0–101; P < .001) for the levonorgestrel intrauterine system and from 311 (range, 81–2506) to 4 (range, 0–182; P < .001) for transcervical resection of the endometrium. Nineteen women of 30 using the levonorgestrel intrauterine system completed the 3-year follow-up compared with 22 of 29 for transcervical resection of the endometrium.

CONCLUSION: Both treatments efficiently reduced menstrual bleeding. The high continuation rate suggests that the levonorgestrel intrauterine system is comparable with transcervical resection of the endometrium.

LEVEL OF EVIDENCE: I

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