Levonorgestrel system, contraceptive combo equally effective for heavy periods

In women with heavy menstrual bleeding, treatment with levonorgestrel intrauterine system is as good as combined oral contraceptives, with both strategies improving bleeding-related quality of life, as reported in a study.

A total of 62 participants (11 percent Black or African American) with self-reported heavy menstrual bleeding were randomly assigned to receive treatment with 52-mg levonorgestrel intrauterine system (n=29) or a monophasic 30- or 35-mcg ethinyl-estradiol containing combined oral contraceptive (n=33) and were included in the intention-to-treat analyses.

The main outcome was mean change in bleeding-related quality of life, as assessed using the 20-question Menstrual Bleeding Questionnaire (score range, 0–75), at 6 and 12 months. Multivariable linear mixed effects regression was used to estimate differences in group means and confidence intervals for the Menstrual Bleeding Questionnaire score.

In the cohort, 19 of 29 participants received the levonorgestrel intrauterine system and 31 of 33 received combined oral contraceptives. Baseline characteristics did not differ between the treatment groups.

Bleeding-related quality of life increased in both the levonorgestrel and combined oral contraceptive groups, as indicated by a significant decrease in Menstrual Bleeding Questionnaire scores beginning at 6 weeks of follow-up.

No significant between-group differences were seen in the mean change in Menstrual Bleeding Questionnaire scores at 6 months (difference, –2.5, 95 percent confidence interval [CI], –10.0 to 5.0) or 12 months (difference, –1.1, 95 percent CI, –8.7 to 6.5). Findings were consistent in the subsets of participants with any follow-up visits (n=52) and who completed all follow-up visits (n=42).

In the per-protocol analyses (n=47), the levonorgestrel group had a significantly greater decrease in Menstrual Bleeding Questionnaire scores at 6 months post-treatment (difference, –7.0, 95 percent CI, –13.8 to –0.2) but not at 12 months (difference, –4.8, 95 percent CI, –11.8 to 2.3) as compared with the combined oral contraceptive group.