A 35-year-old woman presents with heavy menstrual bleeding and severe dysmenorrhea for 2 years. Haemoglobin is 10.2 g/dL. Ultrasound shows a 14-week size globular uterus with myometrial cysts, ill-defined endomyometrial junction, and asymmetric anterior wall thickening. She wishes to preserve the uterus and declines surgery. Which medical therapy is considered the MOST effective first-line option for controlling heavy menstrual bleeding in this condition?
- A Levonorgestrel-releasing intrauterine system (LNG-IUS) ✓
- B Combined oral contraceptive pills
- C Oral tranexamic acid
- D Gonadotropin-releasing hormone (GnRH) agonist for 6 months
Correct answer: A. Levonorgestrel-releasing intrauterine system (LNG-IUS)
Explanation
The clinical picture is adenomyosis. The LNG-IUS (52 mg levonorgestrel) is the most effective first-line medical therapy for heavy menstrual bleeding due to adenomyosis, providing sustained local progestogenic effect on ectopic endometrium with up to 5 years of benefit. GnRH agonists work but are limited to 6 months due to bone loss and are not first-line for long-term bleeding control. Combined OCPs and tranexamic acid are less effective for adenomyosis-related menorrhagia.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.