Heavy menstrual bleeding: what works best in the long term?

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  • Levonorgestrel-releasing intrauterine system (LNG-IUS) was comparable to usual medical treatment for long-term symptom relief and surgery-free survival in patients with heavy menstrual bleeding (HMB).

Why this matters

  • There is a lack of long-term evidence regarding treatment of HMB in the primary care setting.

Study design

  • Multicentre, parallel, open-label trial.
  • Women with HMB (n=571) were randomly assigned to receive LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen–progestogen or progesterone alone).
  • Primary outcome: Patient reported Menorrhagia Multi-Attribute Scale (MMAS).
  • Funding: National Institute of Health Research.

Key results

  • There was a significant improvement in MMAS scores from the baseline in the LNG-IUS and usual treatment groups (mean increase, 44.9 and 43.4 points, respectively; P<.001).
  • There was no significant difference in the MMAS scores amongst both groups (3.9 points; P=.09).
  • 5-y surgery-free survival rates were high in both groups (80% and 77%; P=.6).


  • Individual drugs were not compared with LNG-IUS.
  • Cessation or change in menstrual periods, or cessation of therapy could have affected results.