Левоноргестеловая спираль против обычного лечения для коррекции меноррагии

[Dr.Vad]

Интересная публикация в январском НЕЙМе:

Levonorgestrel Intrauterine System versus Medical Therapy for Menorrhagia
Janesh Gupta, M.D., Joe Kai, M.D., Lee Middleton, M.Sc., Helen Pattison, Ph.D., Richard Gray, M.Sc., and Jane Daniels, M.Sc. for the ECLIPSE Trial Collaborative Group
N Engl J Med 2013; 368:128-137
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MMAS scores improved from baseline to 6 months in both the levonorgestrel-IUS group and the usual-treatment group (mean increase, 32.7 and 21.4 points, respectively; P<0.001 for both comparisons). The improvements were maintained over a 2-year period but were significantly greater in the levonorgestrel-IUS group than in the usual-treatment group (mean between-group difference, 13.4 points; 95% confidence interval, 9.9 to 16.9; P<0.001). Improvements in all MMAS domains (practical difficulties, social life, family life, work and daily routine, psychological well-being, and physical health) were significantly greater in the levonorgestrel-IUS group than in the usual-treatment group, and this was also true for seven of the eight quality-of-life domains. At 2 years, more of the women were still using the levonorgestrel-IUS than were undergoing the usual medical treatment (64% vs. 38%, P<0.001).

Из полной версии следует, что в основе медицинского лечения лежали мефенамовая кислота, транексамовая кислота или их комбинация (всего в 75%); и наибольший эффект от левоноргестреловой спирали был у женщин с ИМТ более 25, тогда как с ИМТ менее 25 разницы по MMAS не было из-за более высокой эффективности мед. лечения в этой подгруппе женщин.