The Effectiveness of Levonorgestrel Releasing Intrauterine System in The Treatment in Premenopausal Age with Heavy Menstrual Bleeding

Background: Endometrial hyperplasia is the abnormal proliferation of endometrial glands due to unopposed estrogen stimulation, often leading to an increased risk of endometrial cancer. The condition is more common than endometrial cancer, particularly in women aged 40-45 for hyperplasia without atypia and 45- 55 for atypical hyperplasia. LNG-IUS reduces hyperplasia risk by differentiating epithelial cells and preventing estrogen-induced proliferation. Aims of the study: To estimate the effectiveness of LNG-IUS in treating heavy menstrual bleeding in premenopausal women. Subjects and Methods: A prospective observational study was conducted at Basrah Maternity and Children Hospital and the private clinic of my supervisor during the period from 1st of June 2023 to 1st of September 2024. It involved 69 premenopausal women with heavy menstrual bleeding (HMB) treated with the LNG-IUS. Participants were screened for eligibility, underwent assessments, and were monitored for menstrual blood loss, side effects, and haemoglobin levels at 4, 12, and 24 weeks post-insertion. Results: The study involved 66 premenopausal women using LNG-IUS, 83.0% of the studied patients with HMB who inserted mirena have marked improvement at the end of the study of 24 weeks post insertion. Median Pictorial blood assessment score chart (PBAC) scores significantly reduced from a pre-insertion score of 290 to 160 at 4 weeks, 85 after 12 weeks and 22 after 24 weeks (p < 0.001). Haemoglobin levels improved from 8.6 ± 0.4 to 10.9 ± 1.2 mg/dl, and serum ferritin rose from 23 ± 16.3 to 65 ± 20.3 ng/ml (both p < 0.001). Common side effects included withdrawal bleeding (31.8%) and vaginal discharge (25.7%). Conclusion: The LNG-IUS significantly reduced menstrual blood loss, improved symptoms in 83% of women, and had a low expulsion rate of the device, and significant increase in haemoglobin and serum ferritin levels following LNG-IUS insertion, indicating effective treatment for HMB.