Levonorgestrel releasing intrauterine system (Mirena) versus endometrial ablation (Novasure) in women with heavy menstrual bleeding: a multicentre randomised controlled trial

Malou C. Herman*, Marian van den Brink, Peggy M. Geomini, Hannah S. van Meurs, Judith A. Huirne, Heleen P. Eising, Anne Timmermans, Johanna M. A. Pijnenborg, Ellen R. Klinkert, Sjors F. Coppus, Theodoor E. Nieboer, Ruby Catshoek, Lucet F. van der Voet, Hugo W. F. van Eijndhoven, Giuseppe C. M. Graziosi, Sebastiaan Veersema, Paul J. van Kesteren, Josje Langenveld, Nicol A. C. Smeets, Huib A. A. M. van VlietJan Willem van der Steeg, Yvonne Lisman-van Leeuwen, Janny H. Dekker, Ben W. Mol, Marjolein Y. Berger, Marlies Y. Bongers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Heavy menstrual bleeding is an important health problem. Two frequently used therapies are the levonorgestrel intra-uterine system (LNG-IUS) and endometrial ablation. The LNG-IUS can be applied easily by the general practitioner, which saves costs, but has considerable failure rates. As an alternative, endometrial ablation is also very effective, but this treatment has to be performed by a gynaecologist. Due to lack of direct comparison of LNG-IUS with endometrial ablation, there is no evidence based preferred advice for the use of one of these treatment possibilities.

Method/design: A multicenter randomised controlled trial, organised in a network infrastructure in the Netherlands in which general practitioners and gynaecologists collaborate.

Women >= 34 years with heavy menstrual bleeding, a Pictorial Blood Assessment Chart (PBAC) score exceeding 150 points and no future child wish can participate in the trial. After informed consent, women will be randomised to a strategy starting with a levonorgestrel releasing intrauterine system or a strategy starting with endometrial ablation.

The primary outcome is the PBAC score at 24 months of follow-up. Secondary outcomes are patient satisfaction, complications, number of re-interventions, menstrual bleeding pattern, quality of life, sexual function, sick leave and costs. As predictors of effect of intervention we also meaure level of coagulation factors.

Discusson: This study, considering both effectiveness and cost effectiveness of LNG-IUS versus endometrial ablation may well improve care for women with heavy menstrual bleeding.

Original languageEnglish
Article number32
Number of pages5
JournalBMC Womens Health
Publication statusPublished - 8-Aug-2013


  • Heavy menstrual bleeding
  • Endometrial ablation

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