Abstract
Objective
To determine whether the levonorgesterol releasing intra-uterine contraceptive device
can safely reduce menstrual blood loss and improve quality of life in patients with
bleeding disorders and those on oral anticoagulation.
Methods
Patients presenting with menorrhagia, without pelvic pathology and suffering from
bleeding disorder or using oral anticoagulants had Mirena inserted at Military Hospital,
Rawalpindi. Baseline hemoglobin and menstrual blood loss was evaluated using pictorial
blood assessment chart. Follow up hemoglobin and menstrual assessments were
performed at 3, 6 and 12 months. At 12 months, patient satisfaction was assessed.
Results
Eighteen patients with bleeding disorders (3 chronic liver disease and 6 on
anticoagulation with warfarin) were included in the study. One patient was lost to follow
up after 3 months. Remaining were followed for one year. Continuity rate was 91% at
one year. Mirena resulted in decrease in menstrual blood loss by 60% at 3 months, 70%
at 6 months and 85 % at one year (p<0.001 for all). Seven (31%) became amenorrhic and
another seven (31%) had intermenstrual spotting. Blood transfusion requirement was
completely eliminated. Patient satisfaction was very high.
Conclusion
In patients with bleeding and coagulation disorders, Levonorgesterol releasing–
intrauterine system provided an efficacious and satisfactory choice in the treatment of
menorrhagia and it reduced the need for blood transfusion and surgery. (Rawal Med J
2009;34: )
Key words: LNG-IUS, menorrahagia, bleeding disorders, CLD
