versus Medical Therapy for Menorrhagia: A Systematic Review and Meta-Analysis

Source of support: Self financing Background: The aim of this study was to compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with conventional medical treatment in reducing heavy menstrual bleeding. Material/Methods: Relevant studies were identified by a search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and clinical trials registries (from inception to April 2014). Randomized controlled trials comparing the LNG-IUS with conventional medical treatment (mefenamic acid, tranexamic acid, norethindrone, medroxypro-gesterone acetate injection, or combined oral contraceptive pills) in patients with menorrhagia were included. Results: Eight randomized controlled trials that included 1170 women (LNG-IUS, n=562; conventional medical treat-ment, n=608) met inclusion criteria. The LNG-IUS was superior to conventional medical treatment in reducing menstrual blood loss (as measured by the alkaline hematin method or estimated by pictorial bleeding assess-ment chart scores). More women were satisfied with the LNG-IUS than with the use of conventional medical treatment (odds ratio [OR] 5.19, 95 % confidence interval [CI] 2.73–9.86). Compared with conventional medical treatment, the LNG-IUS was associated with a lower rate of discontinuation (14.6 % vs. 28.9%, OR 0.39, 95 % CI 0.20–0.74) and fewer treatment failures (9.2 % vs. 31.0%, OR 0.18, 95 % CI 0.10–0.34). Furthermore, quality of life assessment favored LNG-IUS over conventional medical treatment, although use of various measurement