Personally I would consider either trying a cyclic regimen to at least produce a more regular pattern - this is much more easily achieved in postmenopausal women, I am not an advocate of trying to synchronise sequential progestogen with a perimenopausal menstrual cycle but at your stage you may be a good candidate.
Alternatively trying the micronised progesterone vaginally can provide more effective bleed control.
There are also more potent oral progestins that provide better endometrial control than micronised progesterone.
The IUS can be a good option but I would consider this after all non invasive options have been exhausted.
The main reason for this is that should the IUS cause you any problems or you simply want it removed for any reason, you have handed over agency to a third party and are dependent on a clinician to remove it.
This can be difficult and not a quick process especially with the current state of the NHS, and there is often a degree of reluctance to remove them as the device itself is expensive so it is seen as a waste, and in some instances women have been pressured to keep them or really had to fight their corner to get an IUS removed.
Anything you swallow, insert or apply yourself remains in your gift to stop or adjust the dose immediately should you choose.
