Hormone coil for heavy periods
The ECLIPSE trial
Wonderful when years of work come to fruition. My colleague Janesh Gupta and his team from Birmingham and Nottingham had their ECLIPSE trial published in the New Engl J Med this week. Click here.
The results are clear. Popping in a progesterone hormone releasing coil (tradename Mirena) is much more effective than old fashioned oral treatments for women with heavy periods.
I’m thrilled, not just because it’s good to get a clear answer that helps women, but because I’ve been peripherally involved, as chair of the independent trial steering comittee. It was my job to hassle the triallists when recruitment was slow, to threaten to withdraw their funding if they didn’t buck their ideas up, and to pester them when they failed to find out exactly what had happened to every patient. For years Janesh had nightmares about me.
But it’s all worthwhile now. Well done ECLIPSE team.
Jim Thornton
Ripe-tomato.org 
This is a rapid response I publiched in the BMJ in 2005.
Menorrhagia and levonorgestrel IUD dangers
22 April 2005
Reid and Mikri caution that, as over half of patients who have a Mirena inserted in randomised studies go on to have a hysterectomy, we may yet see an increase in surgery over the next three or four years. The epidemiology of Mirena for the management of menorrhagia in primary care is being elucidated by the ECLIPSE study (International Standard Randomised Controlled Trial).
Both the Million Women Study and the Women’s Health found increased risk of breast cancer with progestogen use of less than 12 months. Are there any other International Standard Randomised Controlled Trials designed to expose women to a rapidly acting carcinogen?
The falls in the numbers of hysterectomies are welcome and may also relate to the falls in HRT use due to the publications of studies showing increased risks of venous thromboses, myocardial infarctions, strokes and breast cancers with HRT.
Furthermore progestogens can shrivel the endometrium with atrophy of the endometrial glands and stroma but cause a disproportionate overdevelopment of arterioles, which can cause menorrhagia.2-4
A simple approach is to test for hidden but treatable infections, like mycoplasmas, using endocervical swabs and treat any essential nutritional deficiencies using monitored repletion. Some of my patients have had severe adverse reactions to minimal doses of progesterone or progestogen.
1 Reid PC. Mukri F. Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3 BMJ 2005;330:938-939 (23 April), doi:10.1136/bmj.38376.505382.AE (published 4 February 2005)
2 Grant ECG. Levonorgestrel IUD is not cost effective for dysfunctional bleeding http://bmj.com/cgi/eletters/330/7489/0-f#97883, 25 Feb 2005
3 Grant ECG. Medical treatment for menorrhagia and the cult of progesterone http://bmj.com/cgi/eletters/328/7442/730-d#54980, 29 Mar 2004
4 Grant ECG. Menorrhagia and progesterone dangers http://bmj.com/cgi/eletters/330/7495/834#103644, 12 Apr 2005
It is a pity that even a tiny percentage of the effort expended on female HRT isn’t put into male TRT.