A 28-year-old multiparous woman with a history of menorrhagia and dysmenorrhea seeks long-acting reversible contraception. She has no contraindications to hormonal methods. Which IUCD is the drug of choice for her?

Explanation

## Indication for LNG-IUS in Menorrhagia and Dysmenorrhea **Key Point:** The levonorgestrel-releasing IUCD (LNG-IUS) is the drug of choice for women with menorrhagia and dysmenorrhea seeking contraception, as it addresses both the contraceptive need and the underlying menstrual pathology. ### Mechanism of Benefit 1. **Local progesterone effect** → endometrial suppression → reduced menstrual bleeding (up to 90% reduction) 2. **Analgesic effect** → reduced prostaglandin production → decreased dysmenorrhea 3. **Contraceptive efficacy** → Pearl index 0.2 (comparable to tubal ligation) ### Comparison: Copper vs. Hormonal IUCDs | Feature | Copper T 380A | LNG-IUS | |---------|---------------|----------| | **Menstrual bleeding** | Increases 20–30% | Decreases 90% | | **Dysmenorrhea** | May worsen | Improves significantly | | **Duration** | 10 years | 5–7 years | | **Ideal for** | Nulliparous, normal menses | Menorrhagia, dysmenorrhea | | **Systemic hormones** | None | Minimal (mostly local) | **High-Yield:** LNG-IUS is the **only IUCD that improves menorrhagia**; copper IUCDs worsen it. This is a classic NEET PG discriminator. **Clinical Pearl:** In this patient, LNG-IUS is superior because it simultaneously provides contraception and therapeutic benefit for her menstrual symptoms — a win-win scenario. ### Why Not Copper T 380A? While copper IUCDs are highly effective contraceptives, they **increase menstrual blood loss by 20–30%**, making them contraindicated in women with pre-existing menorrhagia. Copper T 200 is even less effective and also increases bleeding. **Warning:** A common exam trap is offering copper IUCD to a woman with menorrhagia — this would worsen her symptoms and is a poor choice despite high contraceptive efficacy.