International Journal of Clinical Obstetrics and Gynaecology

Background: Heavy menstrual bleeding (HMB) in perimenopausal women significantly affects quality of life and can lead to anemia and surgical intervention. Conservative hormonal management using levonorgestrel-releasing intrauterine system (LNG-IUS) and oral progestins remains the cornerstone of treatment. However, direct comparative data on their efficacy, side effect profiles, and patient acceptability in this population remain limited.

Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics, Bhaarath Medical College and Hospital, Chennai, from February 2020 to January 2021. A total of 120 perimenopausal women with objectively diagnosed HMB were enrolled and randomly allocated into two groups: Group A received LNG-IUS insertion (n=60) and Group B received cyclic oral norethisterone acetate 5 mg twice daily for 21 days per cycle (n=60) over 6 months. Primary outcome measured was reduction in menstrual blood loss (MBL) using the Pictorial Blood Loss Assessment Chart (PBAC) score. Secondary outcomes included changes in hemoglobin levels, side effects, and patient satisfaction.

Results: After 6 months, Group A showed a mean PBAC score reduction of 82.4% versus 61.5% in Group B (p<0.001). Mean hemoglobin rise was 1.9 g/dL in Group A and 1.1 g/dL in Group B (p=0.002). LNG-IUS users reported fewer systemic side effects and higher satisfaction (86.6% vs 63.3%).