Hormone-releasing intrauterine devices (IUDs) do a good
job of alleviating painful, heavy periods — nearly
as good as surgery, according to research published in
the latest edition of the Cochrane Database of Systemic
Reviews. The study authors also found that oral drugs
like NSAIDs, birth control pills and progesterone analogues
offer relatively modest relief from painful or excessive
menstruation.
The more traditional hormone-free
IUDs have the opposite effect — heavier periods
— which is one of the main reasons women ask to
get their IUDs taken out. A WHO study in 1997 found
that menstruation problems prompted about 36% of women
to stop using an IUD over a 12-year period. But lacing
the device with hormones (sometimes called intrauterine
systems or LNG-IUS) gets the pain, bleeding and discomfort
of dysmenorrhea under control. In fact, women are just
as satisfied with this treatment as they are with conservative
surgery — where the lining of the uterus is removed
— or with the more drastic hysterectomy.
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Did you know?
The basic concept behind the
IUD dates back centuries to the Arabian camel
herders who discovered that inserting small stones
in the animal's uterus could prevent pregnancy.
Its use in humans dates back
to the early 19th century but was marred by infections
until German physician Dr Ernst Gräfenburg
came up with a safer design in 1930.
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STEM
THE TIDE
The Cochrane review used data from eight trials looking
at a total of 821 women in Scotland, Finland, New Zealand
and the USA. The reviewers found that even though hysterectomy
is the only 100% effective option, there was no statistically
significant difference in satisfaction rates between
patients who received LNG-IUS, conservative surgery
or hysterectomy one year after treatment.
"While conservative surgery reduced
blood loss more than the IUDs, the two treatments appeared
about equal in terms of patient satisfaction," said
study author Dr Jane Marjoribanks, in a press release.
"Satisfaction with treatment is probably more meaningful
than estimates of blood loss."
The adverse effects of hysterectomy,
including bladder and bowel perforations, infected pelvic
hematomas and peritonitis, were relatively common and
potentially life-threatening, the authors added. There
were 39 complications among 131 women who had a hysterectomy.
THE
IUD STIGMA
The scandal of dangerous Dalkon Shield IUDs of the 1970s
has led to a lingering suspicion of the devices among
North American women — and some of their doctors
— despite the fact that modern IUDs are very safe
and effective. Today the non-medicated copper IUDs are
extremely popular overseas: upwards of 25% of women
in some European countries are fitted with the inexpensive
devices. The hormone-releasing IUD is, however, still
priced out of the reach of many women at about $350
for the device alone.
And even though the study found
that orally administered drugs don't seem to do much
compared to IUDs and hysterectomies, they still have
a role to play. "As effectiveness increases, invasiveness
increases. For some patients, the best treatment is
going to be [drugs], and those patients can avoid the
risks of surgery," Dr Antoni Duleba, of Yale University
School of Medicine, said in response to the findings.
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