Hormone therapy for heavy menstrual bleeding

Cindy Farquhar, Anne Lethaby

Heavy menstrual bleeding affects almost 30% of women, and is a common cause of iron deficiency anaemia.  In severe cases blood transfusions may be required.  Heavy menstrual bleeding can be caused by a hormonal imbalance, endometriosis, fibroids, clotting disorders or reproductive cancers.  In more than half of women with heavy bleeding, no obvious cause can be found.

Heavy menstrual bleeding can affect a woman's fertility if surgery to remove the uterus (hysterectomy) or to destroy the lining of the uterus (ablation) is required.  For younger women who have not yet completed their families, alternative treatments that preserve fertility would be preferable.

A study by Professor Cindy Farquhar and Anne Lethaby compared two treatments for heavy menstrual bleeding (thermal ablation and LNG IUS) to determine which controlled the problem more effectively.  With thermal ablation, a balloon is placed inside the uterus and hot water circulated inside the balloon to permanently destroy the lining of the uterus.  Menstrual bleeding usually lessens or stops altogether, but fertility is usually destroyed.

An alternative to ablation is the Levonorgestrel Intrauterine System (LNG IUS), a hormone therapy originally developed as a contraceptive.  A small device placed inside the uterus releases the hormone progestogen, which stops ovulation and reduces blood flow.  LNG IUS is reversible, and fertility is not destroyed.

The study showed that both treatments are equally effective in reducing menstrual blood loss and both had high levels of patient satisfaction over 24 months of follow-up.  LNG IUS has the added benefit of retaining fertility for younger women.

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