Levonorgestrel releasing intrauterine system versus endometr
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Heavy menstrual bleeding affects the physical functioning and social well-being of many women. The levonorgestrel intrauterine system and endometrial ablation are two frequently applied treatments in women with heavy menstrual bleeding.

Women with heavy menstrual bleeding, aged 34 and older, without a pregnancy wish or intracavitary pathology were randomly allocated to treatment with either the levonorgestrel intrauterine system or to endometrial ablation, performed with the bipolar radiofrequency device (NovaSure). Out of 270 women, 132 women were allocated to the levonorgestrel intrauterine system (baseline PBAC-score 616) and 138 women to endometrial ablation (baseline PBAC-score 630). At 24 months, mean PBAC-scores were 64.8 in the levonorgestrel intrauterine system group and 14.2 in the endometrial ablation group. In the levonorgestrel intrauterine system group 49 women (39%) removed the intrauterine system and 34 women (27%) underwent a surgical re-intervention, compared to 14 women (10%) in the endometrial ablation group. There was no significant difference in patient satisfaction and quality of life between the groups.

Both the levonorgestrel intrauterine system and endometrial ablation strategy lead to a large decrease in menstrual blood loss in women with heavy menstrual bleeding, with comparable quality of life scores after treatment. Nevertheless, there was a significant difference in menstrual blood loss in favor of endometrial ablation, and could not demonstrate non-inferiority of starting with the levonorgestrel intrauterine system. Women who start with the levonorgestrel intrauterine system, a reversible and less invasive treatment, are at increased risk of needing additional treatment, compared to women who start with endometrial ablation. The results of this study will enable physicians to provide women with heavy menstrual bleeding with the evidence to make a well-informed decision between the two treatments.

Source: https://www.ajog.org/article/S0002-9378(20)30844-9/fulltext?rss=yes
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