EFFECTIVENESS OF LNG-IUS IN PERIMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING: A RURAL STUDY

Abstract

Introduction: Abnormal uterine bleeding (AUB) is a common concern among perimenopausal women, often resulting in anemia, social discomfort, and reduced quality of life. The Levonorgestrel Intrauterine System (LNG-IUS) has emerged as a promising non-surgical treatment for managing AUB. This study aimed to evaluate the effectiveness of LNG-IUS in achieving complete symptom resolution within three months of insertion and in reducing bleeding severity and frequency at three and six months. Methodology: A prospective observational study was conducted from January 2020 to August 2022 at a rural hospital in the Ernakulam District. The study included 25 perimenopausal women aged 45–55 years, presenting with AUB and histologically confirmed benign uterine conditions. Participants underwent detailed clinical assessments, baseline investigations, Pap smear, and endometrial biopsy. Transvaginal ultrasound was used to assess pelvic anatomy and endometrial thickness. LNG-IUS insertion was standardized, with pre-procedure cervical softening using misoprostol. Follow-ups were conducted at 4, 12, and 24 weeks post-insertion. Outcome measures included the Pictorial Blood Assessment Chart (PBAC) score, hemoglobin levels, serum ferritin, and endometrial thickness. Results: The mean age of participants was 44.73 years, with 92% being multiparous. Urban residents constituted 68% of the cohort. Comorbidities were present in 48% of participants, most commonly hypothyroidism (41.7%). The average duration of heavy bleeding was 11.12 months. Pre-treatment findings included dysmenorrhea in 56% of participants, a bulky uterus in 36%, adenomyosis in 28%, and fibroids in 20%. Endometrial biopsy revealed simple hyperplasia in 48% and cystic glandular hyperplasia in 16%. After LNG-IUS insertion, most participants reported a marked reduction in bleeding by 12 weeks. By 24 weeks, PBAC scores had significantly decreased, and many participants experienced amenorrhea or minimal spotting. Hemoglobin and serum ferritin levels improved significantly, and ultrasound showed decreased endometrial thickness. Conclusion: LNG-IUS is an effective, well-tolerated, and non-invasive treatment for AUB in perimenopausal women. It significantly reduces menstrual blood loss, improves hematologic parameters, and enhances quality of life. The system is particularly valuable in low-resource settings as a cost-effective alternative to surgery. This study supports the routine use of LNG-IUS for managing AUB in perimenopausal women with benign uterine pathologies.