Comparison of levonorgestrel releasing intrauterin system between oral medroxyprogesterone acetate at the menorrhagia therapy

Medical treatment takes an important place in menorrhagia. In addition, effective medical treatment will reduce unnecessary surgical interventions. So in our study, we compared oral MPA and LNG-RİS on account of efficacy and side effects. This study was conducted at the Department of Obstetrics and Gynecology of Akdeniz University Faculty of Medicine between September 2009-April 2010. Sixty six volunteer women having menorrhagia between the ages 33 and 50 were included in the study. Patients were divided into two groups. First group forming 29 patients were applied LNG-RIS. Second group including 37 patients were used oral MPA (5mg. twice a day, between the 16-25. days of the menstruation cycle). Before the study protocols were implemented to the patients, vital signs of the patients were recorded. Complete blood count, serum biochemical parameters and bleeding profile of the patients were evaluated. Serum iron, total iron binding capacity(TiBC), serum ferritin values of the all patients were also evaluated. Patients in both groups were called for control after 6 months. They were asked to bring their menstruation logs. LNG-RİS was checked with transvaginal sonography in LNG-RİS group and endometrial thickness measured again. For the group of patients using medroxyprogesterone, endometrial thickness were assessed with transvaginal ultrasonography. Complete blood count, serum iron, TiBC, ferritin levels were checked. Modified PBAC values in menstrual diaries were calculated. Drug side effects were questioned. In LNG-RIS group, 2 of 29 patients due to increase in the amount of bleeding and other 2 patients due to dislocation of IUD were excluded from the study. In MPA group, 4 of 37 patients due to increase the amount of bleeding and other 5 patients because of inconsistency in the use of drugs were excluded from the study. While mean hb value of the patients of LNG-RIS group was increased to 11.360 ± 0.8312 g/dL from 10.29±1.175 g/dL, mean hb value of the MPA group was increased to 11.075±0.7575g/dL from 10.39±1.053 g/dL. Hb values showed a significant increase (p=0.001) after treatment in LNG-RIS group. Also, in MPA group hb values also showed a significant increase (p=0.001) after the treatment. When two groups were compared with each other, there is more decrease at the number of bleeding days, number of used pads per day, PBAC scores in LNG-RİS group with respect to MPA group. A statistical significant increase was detected in serum iron and ferritin values in both two groups. As a result, effectiveness of both of the two medical treatment methods are presented either increasing plasma hemoglobin level and decreasing vaginal bleeding. These findings are consistent with the literature. Hence, LNG-RIS therapy is a good alternative to oral MPA according to treatment effectiveness, ease of use, and the low rate of side effects.