Raviele, K. M. (2008). No justification for using IUD to treat menorrhagia. The Linacre Quarterly, 75(3), 177-178. https://doi.org/10.1179/002436308803889530
Raviele KM. No justification for using IUD to treat menorrhagia. Linacre Q. 2008;75(3):177-178. doi:10.1179/002436308803889530
Raviele, Kathleen M. "No justification for using IUD to treat menorrhagia." The Linacre Quarterly, vol. 75, no. 3, 2008, pp. 177-178.
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Dekalb Medical Tucker, Georgia, USA
RRM Academy Synopsis
Mirena IUD for heavy periods has no justification, a physician argues
A 2008 letter argues the Mirena IUD has no justification for treating heavy periods in women of childbearing age. The author, a physician, says the device leaves a risk of ovulation and likely conception in women with normal fertility. She says other treatments are much safer for the woman and put no developing embryo at risk.
Key Findings
The letter accepts the earlier article's figures: the device prevents ovulation 55 percent of the time in year one and 25 percent of the time by year four.
The letter states that for women with normal fertility, the device's ovulation risk of 45 to 75 percent and likely conception would mean significant loss of life after fertilization.
The letter names pelvic inflammatory disease, sepsis, ectopic pregnancy, uterine perforation and embedment of the device as well-known IUD complications, and states that some can lead to permanent sterility.
The letter states that most women with heavy periods have an underlying condition, such as polycystic ovary syndrome (PCOS), fibroids or polyps. PCOS is now named polyendocrine metabolic ovarian syndrome (PMOS).
When ultrasound, hysteroscopy and hormonal evaluation find no underlying pathology, the letter reports that anti-inflammatory medicine on period days reduced bleeding to about half the previous amount.
Interpretation
The letter is an opinion piece. A physician wrote it in reply to an earlier article in the same journal. The argument combines a moral test with clinical points from that article, the manufacturer's literature and three cited papers. The moral test is the principle of double effect, which weighs actions that have both good and harmful effects. The earlier article concerned heavy periods of unknown cause. The letter's conclusion covers heavy periods in women of childbearing age. The loss-of-life conclusion applies to women whose fertility is not reduced.
RRM Context
Restorative reproductive medicine (RRM) looks for the cause of heavy periods before treating them. The letter follows that order. It puts ultrasound, hysteroscopy and hormone tests first, and it proposes cooperative cyclic progesterone for a hormone problem. Suppressive medications, such as the hormonal IUD in the letter, act on the uterine lining while the cause of the bleeding remains.
Our editorial summary of this paper, not the article's abstract.
Abstract
This article questions the conclusions drawn by the author of "The Mirena® Levonorgestrel-releasing Intrauterine System and Its Application to the Treatment of Menorrhagia: A Moral Opinion" (Linacre Quarterly 75 [2008]: 60–70), i.e., that it is justified to use this intrauterine device to treat heavy periods of unknown etiology by the principle of double effect.
