IUD and hysterectomy best options for heavy bleeding

5 February 2018 | Contraception and abortion | Gynaecology | Research and clinical trials

Hormone releasing IUDs are more effective than the contraceptive pill and other medication for treating heavy or abnormal menstrual bleeding a review by Royal Women’s Hospital researchers has found.

Published in the Medical Journal of Australia, the research review found that the use of IUDs as a treatment for uterine bleeding had almost doubled in the past five years.

One in 20 women will experience abnormal uterine bleeding such as heavy or long periods or bleeding in between periods.

Lead researcher Dr Annabelle Brennan said while a hysterectomy provided the most effective treatment for women who have completed their family, the review has shed light on the most effective treatments for women who are wanting to maintain their fertility.

“This study shows that hormone releasing IUDs, such as the Mirena, is the most effective form of non-surgical treatment for abnormal menstrual bleeding,” Dr Brennan said.

Research shows more than 97 per cent of women experienced a reduction in blood loss and around half of patients stopped having their menstrual cycle altogether which is what an IUD – a form of contraceptive - is supposed to achieve.

Satisfaction rates amongst patients appeared to be high with 80 per cent of women continuing to use the IUD 12 months later as treatment for heavy menstrual bleeding, while 96 per cent of women who experienced fibroid problems were using the device a year later. However, more research is needed into patient satisfaction.

“Heavy menstrual bleeding has a significant impact on a woman’s quality of life," Dr Brennan said. "We know women miss work, face bleeding through clothing, often take a change of clothes with them and miss out on activities with friends and family as a result of their heavy bleeding. It is important they are advised of effective treatments.”

Surgery is also used to remove fibroids that may cause heavy bleeding, however problems can return in about a third of cases. Researchers found a hysterectomy including the removal of the uterus was the most effective form of treatment and had very high levels of satisfaction amongst patients.

“The removal of the uterus is the most effective treatment as it removes the source of the bleeding,” Dr Brennan said. ”Current guidelines recommend hysterectomy as a first-line therapy for patients who have finished childbearing and are seeking a definitive treatment of fibroids or for patients with symptoms uncontrolled by minimally invasive management.”

Dr Brennan said the research should provide clear guidance for clinicians in advising patients on the best treatment options for this condition.