Up to 60% of women discontinue using the LNG-IUS within five years because of bleeding irregularities, pain, and systemic progestogenic adverse effects. The study aimed to assess treatment options for bleeding abnormalities in women using the 52 mg LNG-IUS.

Database searches of Medline, Embase/Ovid, and the Cochrane Library were carried out, and journals were searched by hand for relevant studies published from a database. Inclusion criteria were RCTs, prospective cohort studies, and case–control studies of premenopausal women using the LNG-IUS and receiving medical treatment for bleeding irregularities. Two pairs of reviewers carried out screening, data extraction, and quality assessment of retrieved articles independently. The primary outcome was the reduction of bleeding/spotting days.

Of the 3061 studies identified, eight met our inclusion criteria: six RCTs and two prospective cohort studies. The results of our analysis indicated that naproxen might be sufficient for the prophylactic treatment of bleeding immediately after LNG-IUS insertion. Oestradiol may effectively treat ongoing bleeding irregularities >6 months after insertion.

Evidence for the medical treatment of bleeding irregularities during the LNG-IUS use is lacking, and more research is needed on the topic.

Reference: https://www.tandfonline.com/doi/full/10.1080/13625187.2020.1797663