Progestin-releasing intrauterine systems and leiomyoma

Review of the existing published literature suggests that, in women with uterine fibroids, with or without menorrhagia, the high contraceptive efficacy of the levornorgestrel intrauterine system (LNG-IUS) remains intact. In such women, the LNG-IUS reduces menstrual blood loss and likely reduces menstrual pain. However, use of the LNG-IUS does not appear to reduce overall uterine dimensions or those of uterine fibroids. In women with uterine fibroids and menorrhagia, LNG-IUS expulsion rates may be somewhat higher than in women without fibroids. Although symptomatic relief is not guaranteed, these findings indicate that insertion of a LNG-IUS represents an appropriate therapeutic option for selected women with menstrual symptoms associated with uterine fibroids. Questions remain regarding the usefulness of routine preinsertion evaluation of the endometrial cavity as well as ultrasound-guided LNG-IUS insertion. Clinicians who candidly inform their patients regarding what we do and do not know regarding the benefits and risks of the LNG-IUS in women with fibroids should selectively make this therapy available prior to resorting to surgical therapies.