Prospective comparison study of levonorgestrel IUD versus Roller-Ball endometrial ablation in the management of refractory recurrent hypermenorrhea

Abstract

Objective: To compare endometrial ablation and levonorgestrel-IUS for treatment of refractory reccurrent hypermenorrhea.

Study design: 30 patients with refractory recurrent hypermenorrhea were included in a prospective controlled comparative study. A transcervical Roller-Ball ablation was carried out in 15 patients after a 2-months GnRH analog pretreatment. A levonorgestrel IUD (MIRENA(R), Schering AG Berlin, Germany) was inserted in 15 patients for the treatment of hypermenorrhea. In a follow-up of the bleeding behavior over 12-24 months a reduction of bleeding was achieved in 14 of 15 patients after Roller-Ball ablation and in 11 of 15 patients after levonorgestrel IUD insertion. The amenorrhea rates are roughly the same in both groups. Side effects of levonorgestrel IUS were rare and mostly temporary.

Conclusions: The insertion of a levonorgestrel IUD for the local hormonal treatment of recurrent hypermenorrhea refractory to oral treatment can be tried before endometrial ablation. The MIRENA(R) device is particularly advantageous for younger patients who might wish to have more children. The levonorgestrel IUD treatment can replace approx. 75% of endometrial ablations.