A 28-year-old woman with a history of heavy menstrual bleeding is counselled about different IUCD options. She asks which type of IUCD would be most beneficial for her condition. Which of the following is the most common reason for choosing a hormonal IUCD (LNG-IUS) over a copper IUCD?

Question

Accepted Answer

C. Reduction in menstrual blood loss and treatment of menorrhagia. ## Hormonal IUCD (LNG-IUS) vs Copper IUCD: Clinical Indications

**Key Point:** The LNG-IUS is the most commonly preferred IUCD in women with menorrhagia because it reduces menstrual bleeding by 50–90% through direct endometrial suppression.

### Comparative Efficacy in Menorrhagia

| Feature | Copper IUCD | LNG-IUS (Mirena) |
|---------|-------------|------------------|
| Effect on bleeding | **Increases** by 20–30% | **Reduces** by 50–90% |
| Dysmenorrhoea | Worsens | Improves |
| Amenorrhoea rate | <5% | 20–30% at 1 year |
| Endometrial thickness | Normal/increased | Atrophic |
| Ideal for menorrhagia | No (contraindicated) | Yes (therapeutic) |

### Mechanism of LNG-IUS Action on Endometrium

1. **Local hormone release:** 20 μg levonorgestrel/day released directly into uterine cavity
2. **Endometrial atrophy:** Suppresses endometrial proliferation and glandular development
3. **Reduced vascularity:** Decreases endometrial blood vessel formation
4. **Altered prostaglandin profile:** Reduces PGF₂α, limiting uterine contractility
5. **Result:** Dramatically reduced menstrual flow (therapeutic benefit)

**High-Yield:** The LNG-IUS is indicated for:
- Menorrhagia (primary indication)
- Dysmenorrhoea
- Endometrial hyperplasia (preventive/therapeutic)
- Adenomyosis (off-label but effective)

**Clinical Pearl:** In a woman with heavy periods, the LNG-IUS is superior because it **treats the underlying problem** (excessive bleeding) while providing contraception — a "two-for-one" benefit. Copper IUCDs would worsen her symptoms.

### Why Other Options Are Incorrect

- **Cost:** Copper IUCDs are cheaper, but LNG-IUS cost is justified by therapeutic benefit in menorrhagia
- **Ectopic prevention:** Both IUCDs prevent ectopic pregnancy equally well (failure rate ~0.2%)
- **PID risk:** No significant difference between types; risk is highest in first 3 weeks post-insertion

Answer

A. Lower cost and longer duration of action

Answer

B. Reduced risk of pelvic inflammatory disease

Answer

D. Prevention of ectopic pregnancy

A 28-year-old woman with a history of heavy menstrual bleeding is counselled about different IUCD options. She asks which type of IUCD would be most beneficial for her condition. Which of the following is the most common reason for choosing a hormonal IUCD (LNG-IUS) over a copper IUCD?

Explanation

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