Menorrhagia also may be treated with the levonorgestrel-releasing intrauterine devices (IUD). This is a very effective treatment that consistently reduces menstrual

12 20 22

flow by 90% or greater. ' Its use has resulted in the postponement or cancellation of scheduled endometrial resection surgery or hysterectomy. Specifically, 60% of


treated patients have been able to avoid hysterectomy.

FIGURE 49-4. Treatment algorithm for menorrhagia.

Progesterone therapy either during the luteal phase of the menstrual cycle or for 21

days starting on day 5 after the onset of menses results in a 32% to 50% reduction

in menstrual blood loss. Its use has not been shown to be superior to other medical

treatments, including NSAIDs. In addition, it is not associated with any contraceptive benefit.19

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