A Systematic Review of the Levonorgestrel Intrauterine System and its use for Women with Heavy or Prolonged Bleeding

ABSTRACT Objective: To determine from the literature whether it is safe for women with heavy or prolonged bleeding to use the levonorgestrel intrauterine system (LNG-IUS) and to update the evidence prepared for the 2014 MEC Guideline Development Group meeting. Methods: We searched MEDLINE and Cochrane databases for articles (in all languages) published in peer-reviewed journals from April 2006 to July 2013 for articles relevant to heavy or prolonged bleeding and LNG-IUSs. We also used articles identified from a previous systematic review that spanned January 1966 to March 2006. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. Results: Our search from April 2006 to July 2013 resulted in 218 articles, from which we identified 24 studies that met our systematic review criteria. The previous systematic review identified 20 studies and 2 systematic reviews, of which 12 met our inclusion criteria. Overall we included 36 articles from January 1966 to July 2013. "Good" quality evidence from these articles suggested that women with menorrhagia who use LNG-IUSs usually experience decreases in bleeding quantity and pain and increases in hemoglobin and serum ferritin levels. Evidence suggests that some women experience reduction in fibroid size. The studies reported few serious adverse events. Conclusion: "Good" quality evidence suggests that it is safe and potentially beneficial for women with heavy or prolonged bleeding to use LNG-IUSs. Body of Evidence Grading: II-3, GoodMaster of Public Healt