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LNG IUD heavy bleeding — USMLE Step 3 MCQ

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HardOB/GYN (Prenatal / Contraception / Screening)LNG IUD heavy bleedingUSMLE Step 3

A 42-year-old woman has heavy regular menses causing iron-deficiency anemia. Pregnancy testing and endometrial sampling are negative, and ultrasonography shows no intracavitary lesion. She wants highly effective reversible contraception and the greatest sustained reduction in menstrual blood loss. What is the best treatment?

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Correct answer: B — Use a 52-mg levonorgestrel-releasing intrauterine system

The best answer is “Use a 52-mg levonorgestrel-releasing intrauterine system”. The levonorgestrel intrauterine system directly addresses both stated goals. Combined pills, depot medroxyprogesterone, and the implant provide reversible contraception but do not provide the same sustained heavy-menstrual-bleeding benefit; a copper intrauterine device can increase bleeding despite adjunctive tranexamic acid. The 52-mg levonorgestrel intrauterine system is indicated both for highly effective contraception and for treatment of heavy menstrual bleeding in patients choosing intrauterine contraception.

Reference: FDA: Mirena Prescribing Information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/021225s043lbl.pdf