Abeera Choudry, Ayesha Malik, Humaira Choudry, Naila Bangish, Naheed Hayat.
Effectiveness and safety of levonorgestrel releasing intrauterine system in treatment of menorrhagia secondary to oral anticoagulations and chronic liver disease.
Rawal Med J Jan ;34(2):187-90.

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.

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