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Statistics indicate that one-third of outpatient gynecologist visits are for abnormal uterine bleeding, with the condition accounting for more than 70% of gynecologic consultations in the perimenopausal and postmenopausal years.
Statistics indicate that one-third of outpatient gynecologist visits are for abnormal uterine bleeding, with the condition accounting for more than 70% of gynecologic consultations in the perimenopausal and postmenopausal years.1 Although medical therapies such as combined oral contraceptives commonly are used to treat the condition, the levonorgestrel-releasing intrauterine device (LNG-IUD) has become an increasingly popular treatment option.
Michael Thomas, MD, chief of the division of reproductive endocrinology and infertility at the University of Cincinnati College of Medicine, looks at the LNG-IUD as a safe and effective treatment option, particularly for patients who not only want to control their bleeding, but also want to maintain their fertility potential.
Thomas, a member of the research team responsible for developing the LNG-IUD, served as an advocate for the method during a recent debate at the 2018 American College of Obstetricians and Gynecologists’ (ACOG) annual clinical meeting.2
Birth control pills or other oral options used in controlling abnormal uterine bleeding issues must be taken to be effective, says Thomas, a reproductive endocrinologist. The LNG-IUD remains in place, providing needed therapy, and can be removed when a woman chooses to become pregnant.
Research from seven studies indicates that the LNG-IUD is an effective intervention for reduction of abnormal cyclic uterine bleeding.3 Data suggest 70-87% reductions in bleeding when comparing numbers for treated women with their baseline.4-8 Eighty percent or more of women who were enrolled in studies because they met criteria for heavy menses achieved normal total blood loss, with such improvements showing significant movement when compared with women treated with nonsteroidal anti-inflammatory drugs (NSAIDs), combined oral contraceptives, progestogens, and usual care.3
The LNG-IUD represents a good option for patients with abnormal uterine bleeding who wish to skirt the potential side effects of oral medications, Thomas says.
“People who have issues with progestin-related problems, such as mood changes, nausea, or bloating, may not have that with the IUD, because very little of the medication gets into the peripheral bloodstream,” notes Thomas. “The advantage of this type of local device that is inside the uterus is that it actually has a direct effect, as opposed to taking something by mouth, which has to go through the liver and may not have a good effect.”
There is no one-size-fits-all approach to the treatment of abnormal uterine bleeding, says Kristen Matteson, MD, MPH, director of the division of research for the department of obstetrics and gynecology at the Warren Alpert Medical School of Brown University and Women & Infants Hospital in Rhode Island. Matteson served as advocate for other medical options at the recent debate.
Heavy menstrual bleeding adversely affects women’s lives, explains Matteson. It may cause them to change their work schedule or change plans with their friends and their family, making a major impact on their day-to-day lives, she notes.
“I think it’s great that we have so many different treatment options, but any treatment that you are looking at giving to a woman with heavy menstrual bleeding needs to address what she is finding most bothersome about her symptom to reduce the adverse impact that bleeding has on her daily life,” she states.
According to a recent survey of ACOG members, combined oral contraceptives were the most commonly chosen first-line choice for abnormal uterine bleeding treatment. Birth control pills can correct menstrual irregularities that result from oligo-ovulation or anovulation, which helps to make menstruation more predictable. Combined oral contraceptives also can decrease excessive menstrual bleeding for most women, which makes them an initial management option in treat heavy menstrual bleeding.
Nonsteroidal anti-inflammatory drugs commonly are used to treat abnormal uterine bleeding because of the role of prostaglandins in the pathogenesis of heavy menstrual bleeding. These drugs inhibit the enzyme cyclooxygenase, thereby lowering endometrial prostaglandin levels and decreasing potential for vasodilation and angiogenesis.3 When compared with placebo, data suggest such drugs decrease menstrual cramping and reduce menstrual blood loss by 33%.10
Tranexamic acid blocks lysine-binding sites on plasminogen, which prevents plasmin and fibrin polymer interaction. This results in degradation of fibrin, stabilization of clots, and reduction in bleeding.11 Research indicates use of the drug results in significant decrease in the objective measurement of idiopathic heavy menstrual bleeding.11
Financial Disclosure: Consulting Editor Robert A. Hatcher, MD, MPH, Nurse Planner Melanie Deal, MS, WHNP-BC, FNP-BC, Author Rebecca Bowers, Washington Watch Author Adam Sonfield, Executive Editor Shelly Morrow Mark, Copy Editor Savannah Zeches, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.