45-year-old woman. Two previous pregnancies with normal deliveries (G2PN2). Heavy menstrual bleeding for approximately 1 year. Ultrasound shows a 2 cm subserosal myoma that has been stable for several years. Endometrial biopsy was performed and it was normal. The patient has hemoglobin 10 g/dL despite oral ferrotherapy and the amount of menstrual flow has not decreased despite treatment with tranexamic acid and mefenamic acid. Which of the following is the treatment of first choice in this patient?
According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option.
Total hysterectomy preserving appendages.
Combined oral contraceptives.
Endometrial ablation.
Levonorgestrel IUD.
According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option.