The impact of hormonal intrauterine device use on health-related quality of life in women with a history of venous thromboembolism: a systematic review

To systematically review the available evidence on changes in health-related quality of life (HRQoL) associated with the levonorgestrel-releasing intrauterine system (LNG-IUS) for contraception or menstrual bleeding management in women with a history of venous thromboembolism (VTE), regardless of anticoagulant use. This systematic review was conducted following Cochrane Collaboration guidelines and the PRISMA statement. A comprehensive search was carried out in PubMed, Embase, Cochrane Central, Scopus, Web of Science, and the Virtual Health Library (VHL), without language or date restrictions. Four observational studies met the inclusion criteria, encompassing 32 women from non-randomised cohorts and case series. Among these patients, 81% experienced a reduction in menstrual blood loss, and satisfaction rates were ≥70%. No significant adverse events were reported. The LNG-IUS appears to be a valuable option for improving HRQoL in women with a history of VTE, particularly through its effectiveness in reducing menstrual bleeding. It may be especially beneficial for those receiving anticoagulation therapy. To our knowledge, this is the first systematic review focused on HRQoL outcomes with LNG-IUS in this population, highlighting the importance of individualized contraceptive and menstrual management in women with increased thrombotic risk. Further high-quality studies are needed to strengthen these findings.