A 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) and radiofrequency nonresectoscopic endometrial ablation (EA) have similar risks of long-term reintervention for heavy menstrual bleeding (HMB), but the former has increased surgical reintervention risk, according to a recent study in the American Journal of Obstetrics & Gynecology.1
Takeaways
- Both the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) and radiofrequency nonresectoscopic endometrial ablation (RF NREA) have comparable long-term reintervention rates for treating heavy menstrual bleeding.
- Patients using the 52-mg LNG-IUS experienced a higher rate of surgical reinterventions (35.3%) compared to those undergoing RF NREA (19.1%).
- 25.9% of women in the LNG-IUS group required subsequent endometrial ablation, whereas no women in the RF NREA group needed this procedure.
- Hysterectomy rates were similar between the two groups, with 11.8% in the LNG-IUS group and 18.1% in the RF NREA group.
- Both treatments resulted in high rates of amenorrhea and patient satisfaction, with 95.1% and 97.8% achieving amenorrhea, and satisfaction rates of 74.0% and 84.4%, respectively, for LNG-IUS and RF NREA.
HMB, which is reported in approximately half of adult European women, significantly impacts patients’ quality of life (QOL). While LNG-IUS is considered a first-line treatment option, data has indicated discontinuation within 2 years among 39% of patients, suggesting a need for other treatment options.
Combined oral contraceptives have also been indicated as effective treatments for HMB, with similar EuroQol EQ-5D results to LNG-IUS.2 Similar major adverse events have also been found between treatment methods.
EA and hysterectomy are common surgical treatment options for patients with HMB.1 While hysterectomy is considered invasive and has a relatively long recovery time, EA has been proven both safe and effective.
To compare the safety and efficacy between a 52-mg LNG-IUS and radiofrequency nonresectoscopic EA, (RF NREA), investigators conducted a multicenter randomized controlled trial. Participants included women with a Pictorial Blood Loss Assessment Chart (PBAC) score above 150 points.
Patients aged under 34 years or those with desire to conceive, abnormal cervix cytology up to 5 years, intracavitary structures, substantial intramural fibroids, or a large uterus were excluded. Participants were randomized 1:1 to receive a 52-mg LNG-IUS or RF NREA.
The reintervention rate after long-term follow-up (FU) was measured as the primary outcome of the analysis, determined through responses to 6 online questionnaires. Surgical reinterventions included EA, hysterectomy, hysteroscopic or laparoscopic myomectomy, hysteroscopic adhesiolysis, and uterine fibroid embolization.
Drug interventions such as estrogen, progestogen, combined hormonal contraceptives, tranexamic acid, gonadotropin-releasing hormone analog, and antiprogestogen were also included in the primary outcome. Secondary outcomes included QOL, menstrual blood loss, menstrual pain indicators, spotting, amenorrhea, sexual function, and patient satisfaction.
