There is good news for women with bleeding disorders looking for a new option in contraception. Researchers have shown that an intrauterine device (IUD) that releases levonorgestrel, a synthetic form of the hormone that regulates cyclic growth and breakdown of the uterine lining, controls hemostatic disorders of the uterus and serves as a birth control method.
Once inserted, this small, T-shaped piece of plastic, called the Mirena® (manufactured by Bayer HealthCare), releases levonorgestrel at a rate of about 7 ounces a day during a five-year period. It was approved by the US Food and Drug Administration for birth control in 2000.
In the September 2008 issue of Fertility and Sterility, Andrea Lukes, MD, MHSc, FACOG, president and CEO of the Carolina Women’s Research and Wellness Center in Durham, North Carolina, described the cases of seven women with abnormally heavy menstrual uterine bleeding (menorrhagia). Participants ranged in age from 28 to 48 years with a median age of 38 years. Four of these women had von Willebrand disease (VWD) and four were on anticoagulation therapy—aspirin or warfarin—at the time. One participant had both VWD and factor V Leiden.
Bleeding days decreased in five out of seven, or 71%, of the women who used the IUD; the median number of bleeding days dropped from nine per month to three. The other two, or 29%, of the subjects reported no improvement of symptoms, but the majority claimed a significant improvement in quality of life. Future studies with much larger numbers of subjects will be needed, but the results from this small study are encouraging.
Further, the Mirena can be used as a birth control method for women with bleeding disorders. The pregnancy rate with the device is 0.1%. If the patient decides she wants to become pregnant, it is easily reversible.
“The levonorgestrel-releasing intrauterine is a great choice for women with hemostatic disorders, for both contraception and for treatment of heavy periods,” affirms Lukes. “I consider it a safe and effective choice.”
The National Hemophilia Foundation strongly recommends that women who suspect they might have an underlying bleeding or clotting disorder first undergo testing and receive a proper diagnosis at a hemophilia treatment center. Once diagnosed, they can work with their physicians to make an informed choice on appropriate menorrhagia treatment.