Advantages wth Using the Levonorgestrel-Releasing Intrauterine System in Females with Hemostatic Disorders.

BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a small device placed within the uterus that is used for both contraception and treatment of menorraghia. This system releases 20 micrograms of levonorgestrel every 24 hours over 5 years. We hypothesized that females with inherited or acquired bleeding disorders would have decreased menstrual bleeding with the LNG-IUS and improved quality of life.

METHODS: A small, retrospective case series of females with hemostatic disorders who used the LNG-IUS within a 2 year period and who were seen at a tertiary medical center.

RESULTS: Seven females were treated with the LNG-IUS for menorrhagia and contraception. We did not reverse anticoagulation for placement of the device and there were no bleeding complications associated with the LNG-IUS insertion. The average age was 36.7 years (range 28 – 48 years). Four females had von Willebrand’s disease (VWD). Four females were on antithrombotic therapy, 2 warfarin and 2 aspirin. One female with VWD was heterozygous for factor V Leiden and was on warfarin for treatment of deep venous thrombosis. Six females had menorrhagia and one had bleeding most of the time. The average days of menstrual bleeding prior to LNG-IUS was 8.3 days which improved to 4.5 days after placement of the LNG-IUS. Three of 7 females discontinued use of the LNG-IUS, yet one had the LNG-IUS removed because she no longer required contraception. This female became pregnant and after an uncomplicated normal spontaneous vaginal delivery elected to use the LNG-IUS again for contraception and the benefit of decreased menstrual bleeding. The other 2 females (2/7, 29%) discontinued use of the LNG-IUS because there was worsening of heavy menses or ‘failed’ therapy - one with VWD and one on anticoagulation. The female on anticoagulation in this case also had significant uterine fibroids. A ten item quality of life questionnaire developed by Kouides was administered, and showed overall improvement in quality of life.

CONCLUSION: The levonorgestrel-releasing intrauterine system is an effective method of contraception and an effective treatment for heavy menses. For females with hemostatic disorders, this device has unique advantages: it is technically easy to use in females at increased bleeding risk, offers effective control of menorrhagia, and may likely improve overall quality of life. Additional prospective large scale studies are required to validate these findings.