Women's preferences for the levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding

M. Brink, Marian J van den Brink, Pleun Beelen, Malou C. Herman, Nathalie J J Claassen, Marlies Y. Bongers, Peggy M. A. J. Geomini, Peggy M Geomini, Jan Willem van der Steeg, Lotte van den Wijngaard, Madelon van Wely
European journal of obstetrics, gynecology, and reproductive biology · 2018 · vol. 228 , pp. 143–147 · doi:10.1016/j.ejogrb.2018.06.020 · PMID:29945042 · W2808469343
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This study investigated women's preferences for the levonorgestrel intrauterine system and endometrial ablation as treatments for heavy menstrual bleeding.

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Abstract

OBJECTIVES: Women's preferences for treatment of heavy menstrual bleeding (HMB) are important in clinical decision-making. Our aim was to investigate whether women with HMB have a preference for treatment characteristics of the levonorgestrel intrauterine system (LNG-IUS) or endometrial ablation and to assess the relative importance of these characteristics. STUDY DESIGN: A discrete choice experiment was performed in general practices and gynaecology outpatient clinics in the Netherlands. Women with HMB were asked to choose between hypothetical profiles containing characteristics of LNG-IUS or endometrial ablation. Characteristics included procedure performed by gynaecologist or general practitioner; reversibility of the procedure; probability of dysmenorrhea; probability of irregular bleeding; additional use of contraception; need to repeat the procedure after five years; and treatment containing hormones. Data were analysed using panel mixed logit models. The main outcome measures were the relative importance of the characteristics and willingness to make trade-offs. RESULTS: 165 women completed the questionnaire; 36 (22%) patients were recruited from general practices and 129 (78%) patients were recruited from gynaecology outpatient clinics. The characteristic found most important was whether a treatment contains hormones. Women preferred a treatment without hormones, a treatment with the least side effects, and no need for a repeat procedure or additional contraception. Women completing the questionnaire at the gynaecology outpatient clinic differed from women in primary care in their preference for a definitive treatment to be performed by a gynaecologist. CONCLUSIONS: Whether or not a treatment contains hormones was the most important characteristic influencing patient treatment choice for HMB. Participants preferred characteristics that were mostly related to endometrial ablation, but were willing to trade-off between characteristics.

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MeSH descriptors

Endometrial Ablation Techniques Levonorgestrel Menorrhagia Menorrhagia Patient Preference Adult Endometrial Ablation Techniques Female Humans Intrauterine Devices, Medicated Levonorgestrel Menorrhagia Menorrhagia Middle Aged Patient Preference

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