Analysis of Non-responders to LNG-IUS in Cases of Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) or menorrhagia, a common complaint among women during their reproductive years, significantly impacts women's quality of life, productivity, and healthcare costs. The treatment options range from conservative medical management to minimally invasive procedures and hysterectomy. While levonorgestrel-intrauterine system (LNG-IUS) is established as an effective treatment for HMB, there is a lack of significant research on factors determining non-response in women with HMB. This study aims to analyse the factors behind non-response to LNG-IUS in women with HMB.

A retrospective observational study was conducted at BARC Hospital, Mumbai, from January 2017 to March 2020, including 88 patients with HMB who received LNG-IUS. Non-responders to LNG-IUS were analysed for reasons of failure, including endometrial thickness, hysteroscopy, and biopsy reports. Patients were contacted one year later to assess treatment outcomes, and alternative treatments or surgery was offered to non-responders, with final histopathological findings documented.

In this study, 29.5% of patients were non-responders, with the majority aged 40-44 years, and most experiencing persistent heavy bleeding, dysmenorrhea, device expulsion, or misplacement. Half of the non-responders had an endometrial thickness of less than 10 mm and proliferative endometrium on biopsy. Nine patients underwent hysterectomy, with adenomyosis found in seven of them.

LNG-IUS is effective in treating HMB, but factors, such as age, endometrial thickness, and certain underlying structural and non-structural pathologies, may contribute to non-response.