Comparing the effects of intrauterine progestin system and oral progestin on health-related quality of life and Kupperman index in hormone replacement therapy

Aim: The aim of this study was to compare the effects of intrauterine‐system‐releasing 20 µg daily of levonorgestrel (LNG IUS) plus 1 mg 17 beta‐estradiol daily, orally with combined oral pill containing 1 mg 17 beta‐estradiol/2 mg drospirenone daily as hormone replacement therapy, on health‐related quality of life (HRQoL) and climacteric symptoms in postmenopausal women. Materials and Methods: A 6‐month prospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. Ninety postmenopausal women were accepted to be part of the study. The Euro Quality of Life‐5 Dimensions (EQ‐5D) and Euro Quality of Life Visual Analogue Scale (EQ VAS) indexes for HRQoL and Kupperman indexes were compared between two groups of patients. Results: Kupperman indexes of both treatment groups decreased gradually over 6 months, but indexes decreased significantly more in the group with intrauterine‐system‐releasing 20 µg daily of levonorgestrel. Elevations were observed in EQ‐5D indexes and VAS values of both groups. EQ VAS values significantly increased in the group on intrauterine progestogen system. Similar changes were observed in the EQ‐5D indexes of both groups. Conclusion: A hormone replacement therapy regimen that includes an intrauterine progestin system decreased climacteric symptoms and increased HRQoL in postmenopausal women during a follow‐up period of 6 months. The extent of the relief of symptoms was greater in this group than in women receiving oral combined hormone replacement therapy. It seems therefore that the intrauterine progestin system could represent a method of choice for endometrial suppression in women using estrogen replacement therapy with distinct advantages over systemically administered progestogens, which have been the subject of considerable debate as reported in the recent literature.