We should encourage more women to use the modern IUD

More: The IUD can treat common gyn problems

IUDs are not approved by the FDA to treat gynecologic disease. Recently published data indicate, however, that a levonorgestrel-releasing intrauterine system (IUS) is effective for treating excessive menstrual bleeding and pelvic pain caused by endometriosis.

Menstrual bleeding. Randomized studies have reported that the levonorgestrel IUS reduces heavy menstrual bleeding. In head-to-head comparison of the levonorgestrel IUS with endometrial resection and with endometrial balloon ablation, for example, patient satisfaction was similar with all treatments, although endometrial resection and balloon ablation reduced self-reported blood loss more than the levonorgestrel IUS.⁷

In another randomized trial, treatment of heavy menstrual bleeding with the levonorgestrel-containing device was better accepted by patients than treatment with oral norethindrone.⁸ Forty-four women with self-reported menorrhagia, measured menstrual blood loss of >80 mL/cycle, normal pelvic exam, and normal cervical cytology were randomized to a levonorgestrel IUS or norethindrone, 15 mg daily, for cycle days 5 through 26. The IUS and norethindrone reduced measured blood loss by 94% and 87%, respectively.

After 3 months of treatment, 76% of subjects treated with the levonorgestrel IUS requested that they be allowed to continue treatment. In contrast, only 22% of women treated with norethindrone requested to continue treatment with the oral progestin.

Why were women in the levonorgestrel IUS group more likely to elect to continue treatment? Specific reasons were not detailed in the report, but it is likely because the device greatly reduced menstrual bleeding and was associated with few side effects.

Pelvic pain. As mentioned, several trials have demonstrated that the levonorgestrel IUS is effective for treating pelvic pain caused by endometriosis.^9-11

And other evidence. Additional reported uses of the levonorgestrel IUS include treatment of endometrial hyperplasia¹² and prevention of endometrial polyps in women who take tamoxifen.¹³

We can make the difference in boosting utilization

Many factors contribute to the low rate of IUD use in the United States. One obstacle, the crisis over the Dalkon Shield, is now decades old—a distant memory for older clinicians and beyond the experience of a new generation of women and clinicians. If physicians put greater emphasis on expanding the use of the modern IUD, we would likely help increase the number of American women who benefit from this device.