In a recent editorial, Miriam Santer1 highlights what little we know about quality of life and patient satisfaction following treatment for heavy menstrual bleeding. She points in particular to the paucity of relevant data comparing the levonorgestrel-releasing intrauterine system (LNG-IUS or Mirena®) with other medical treatments. Therefore, we agree that the recommended ranking in recent NICE guidelines,2 suggesting Mirena coil as the first option for heavy menstrual bleeding, seems premature, may fail to account for patient preferences, and indeed lead to problems with concordance and therefore efficacy of treatment.
We are currently seeking to address some of this evidence gap in ECLIPSE, a large, randomised controlled trial assessing clinical effectiveness and cost-effectiveness of the LNG-IUS versus standard medical treatments for initial management of heavy menstrual bleeding in primary care and gynaecology settings (www.eclipse.bham.ac.uk). Outcomes include menorrhagia-specific and generic quality-of-life measures, and surgical interventions, with long-term follow-up at 2 and 5 years.
Unsurprisingly, we have found recruitment particularly challenging because many women have a strong personal preference for one form of treatment or another. Within, and alongside, the trial we are seeking qualitative data in order to understand women's experiences of treatments including those of women with strong treatment preferences. This investigation seeks to build on work examining social factors and influences on women's perceptions of heavy menstrual bleeding and perceptions of health professionals in this context.3,4
Thus, we aim to provide evidence not only on the long-term effectiveness and cost-effectiveness of medical treatments for heavy menstrual bleeding, but also to enhance understanding of receiving treatments from women's perspectives. As Santer notes, much further research is needed to promote a more holistic approach to women experiencing this common and complex condition.