Levonorgestrel-Releasing Intrauterine System versus Endometrial Ablation for Heavy Menstrual Bleeding: A Systematic Review

Abstract

Introduction: Heavy menstrual bleeding (HMB) is a common condition affecting women's quality of life. The levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial ablation are two common, minimally invasive treatment options. This review compares their effectiveness.

Methods: A search for RCTs was conducted comparing the LNG-IUS to second-generation endometrial ablation techniques for the treatment of HMB. The primary outcome was treatment success, defined by patient satisfaction and reduction in menstrual blood loss.

Results: The analysis of seven RCTs showed that both the LNG-IUS and endometrial ablation were highly effective in reducing menstrual blood loss and improving quality of life. Success rates were comparable at 1 and 2 years. The LNG-IUS offers the additional benefit of contraception and is reversible.

Discussion: Both treatments are excellent alternatives to hysterectomy. The choice should be guided by the patient's need for contraception, desire for reversibility, and preference for an office-based versus a surgical procedure.

Conclusion: The LNG-IUS and endometrial ablation are equally effective for the treatment of heavy menstrual bleeding.