Costo del retiro anticipado de métodos de planificación familiar / Cost of early removal of family planning methods

Resumen OBJETIVO: Determinar el costo del retiro anticipado de los métodos de planificación familiar. MATERIALES Y MÉTODOS: Estudio de costo efectuado con base en los expedientes de usuarias de métodos de planificación familiar en una institución de salud del estado de Querétaro, México (2018 a 2021). La unidad de observación fue el expediente de mujeres que se retiraron anticipadamente los métodos: dispositivo intaruterino T de cobre (DiuTcu), Diu Mirena (DiuM) e implante subdérmico (IMSD). Se definió como retiro anticipado al sucedido antes del tiempo estimado de uso. Se analizaron todos los expedientes en donde estaba registrado el retiro anticipado. Se incluyó a toda la población, de ahí que no fue necesario establecer el tamaño de muestra. El costo del retiro anticipado se identificó a partir del costo unitario del método, tiempo esperado de uso y tiempo de no uso. El análisis estadístico incluyó: promedios, porcentajes, intervalos de confianza y proyecciones, para esto se utilizaron supuestos. RESULTADOS: Se estudiaron 1361 expedientes. El costo unitario del retiro anticipado del DiuTcu fue de 5.59 pesos (IC95%: 5.04 a 6.14), del DiuM de 1210.73 pesos (IC95%: 1029.58 a 1391.87) y del IMSD de 658.41 pesos (IC95%: 557.37 a 759.44). La proyección a la población mexicana del costo del retiro anticipado de los métodos de planificación familiar es 219,272,470 de pesos. CONCLUSIÓN: El costo del retiro anticipado de los métodos de planificación familiar es alto.

Abstract OBJECTIVE: To determine the cost of early removal of family planning methods. MATERIALS AND METHODS: Cost study realized in records of women users of family planning method in a health institution in Querétaro, Mexico from 2018 to 2021. The unit of observation was considered to be the records of women who had early removal of the copper IUD, Mirena IUD and subdermal implant methods. Early removal was defined as the retirement of the method before the estimated time of use. Work was done with the total number of records (1361), with early removal in 148 (83 copper IUDs, 28 Mirena IUDs, 37 subdermal implants). The entire population was included, so no sampling technique was used. The cost of early removal was identified from the unit cost of the method, expected time of use, time of non-use. The statistical analysis plan included averages, percentages, confidence intervals and projections for which assumptions were used. RESULTS: The unit cost of early removal of copper IUD was $5.59 (95% CI; 5.04-6.14), Mirena IUD $1210.73 (95% CI; 1029.58 - 1391.87) Subdermal implant $658.41 (95% CI; 557.37- 759.44). The projection to the Mexican population of the cost of early removal of family planning methods is $359, 384,161. CONCLUSION: The cost of early removal of family planning methods is high.

Mirena: a novel alternative to hysterectomy

Background: To study the awareness and efficacy of Mirena (Levonorgestrel intrauterine system) in treatment of abnormal uterine bleeding.Methods: A prospective analytical study was conducted from January 2012 to June 2018 at Smt. Kashibai Navale medical college and general hospital, Pune, Maharashtra, India. Total 30 women between age of 35 to 45 yrs age were included in the study. Mirena was inserted post-menstrually in the operation room under sedation was done. The women were called for follow-up after 1 month, then 4 months, and then yearly (for maximum 2 years); and asked regarding the relief they have obtained from the antecedent menstrual complaints.Results: At end of study, Overall satisfaction rate among women was 76.67% and decrease menstrual blood flow observed in 20 (74.07%) cases. Most common side effect observed was irregular menses in 6 (22.22%) cases. Hysterectomy was required in 3 (11.11%) cases.Conclusions: Menorrhagia is a common gynaecologic problem often needing hysterectomy. The LNG-IUS reduces bleeding in women with menorrhagia due to benign causes. The patient acceptance and satisfaction is high. Main problem is irregular bleeding especially for the first 3 months after insertion. If the patients can be counseled before insertion, continuation rates for LNG-IUS are high. It has the potential to replace hysterectomy as treatment of choice in certain patients.

Six months response rate of combined oral medroxyprogesterone/levonorgestrel-intrauterine system for early-stage endometrial cancer in young women: a Korean Gynecologic-Oncology Group Study / 부인종양

OBJECTIVE: To evaluate the efficacy of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment and to compare the diagnostic accuracy of endometrial aspiration biopsy with dilatation & curettage (D&C) in young women with early-stage endometrial cancer (EC) who wished to preserve their fertility. METHODS: A prospective phase II multicenter study was conducted from January 2012 to January 2017. Patients with grade 1 endometrioid adenocarcinoma confined to the endometrium were treated with combined oral MPA (500 mg/day)/LNG-IUS. At 3 and 6 months of treatment, the histologic change of the endometrial tissue was assessed. The regression rate at 6 months treatment and the consistency of the histologic results between the aspiration biopsy and the D&C were evaluated. RESULTS: Forty-four patients were enrolled. Nine voluntarily withdrew and 35 patients completed the protocol treatment. The complete regression (CR) rate at 6 months was 37.1% (13/35). Partial response was shown in 25.7% of cases (9/35). There were no cases of progressive disease and no treatment-related complications. A comparison of the pathologic results from aspiration biopsy and D&C was carried out for 33 cases. Fifteen cases were diagnosed as “EC” by D&C. Among these, only 8 were diagnosed with EC from aspiration biopsy, yielding a diagnostic concordance of 53.3% (ĸ=0.55). CONCLUSION: Combined oral MPA/LNG-IUS treatment for EC showed 37.1% of CR rate at 6 months. Considering the short treatment periods, CR rate may be much higher if the treatment continued to 9 or 12 months. So, this treatment is still a viable treatment option for young women of early-stage EC. Endometrial aspiration biopsy with the LNG-IUS in place is less accurate than D&C for follow-up evaluation of patients undergoing this treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01594879

Therapeutic efficacy of Mirena in gynecologic disease

The levonorgestrel-releasing intrauterine system (LNG-IUS) was originally developed as a method of contraception and was first marketed in Finland in 1990. In Korea, the only LNG-IUS approved for non-contraceptive use is Mirena, a T-shaped device with a vertical stem containing a reservoir of 52 mg of levonorgestrel, which releases 20 µg of levonorgestrel per day. The device's strong local effects on the endometrium benefit women with gynecological conditions such as heavy menstrual bleeding, dysmenorrhea, leiomyoma, adenomyosis, and endometriosis. There is also evidence to support its role in endometrial protection during postmenopausal estrogen therapy and in the treatment of endometrial hyperplasia without atypia and, possibly, early endometrial cancer. Because of its effectiveness, safety, and high patient satisfaction, the LNG-IUS will continue to provide important benefits in women's reproductive health.

Comparison of the Clinical Effects and Improvement of Serum Hormone Levels of Kidney Tonifying and Blood Circulation Recipe and Mirena in the Treatment of Perimenopasual Dysfunctional Uterine Bleeding / 现代生物医学进展

Objective:To compare the clinical effects and improvement of serum hormone levels of kidney tonifying and blood circulation recipe and mirena in the treatment of perimenopasual dysfunctional uterine bleeding.Methods:92 cases of perimenopausal patients with dysfunctional uterine bleeding in our hospital from July 2013 to November 2016 were selected and divided into group A and group B with 46 cases in each group.Group A was orally administered with kidney tonifying and blood circulation recipe,and group B was administered with mirena.Both groups were treated for 3 periods.The efficacy and incidences of adverse effect in two groups were observed.The levels of serum hormones and hemoglobin (Hb),and endometial thickness (ET) were detected in two groups.The indices of serum hormone included follicle-stimulating hormone (FSH),luteinizing hormone (LH),progestone (P) and estradiol (E2).Results:No significant difference was found in the total effective rate between two groups (P＞0.05).After treatment,the levels of serum FSH,LH,E2 and P as well as ET and Hb in both groups were all significantly lower than those before treatment (P＜0.01),and the levels of serum FSH,LH,E2 and P as well as ET of group B were significantly lower than those of group A (P＜0.01),no significant difference in the Hb level between two groups (P＞0.05).The incidence of adverse reactions of group B (15.22％) was significantly higher than that of group A(0％) (P＜0.01).Conclusions:The kidney tonifying and blood circulation recipe had similar effect as mirena in the treatment of perimenopasual dysfunctional uterine bleeding,while mirena had strong improving effect in serum hormone level and ET,kidney tonifying and blood circulation recipe had higher security.

Application of medical cooperation health education after conservative surgery placed Mirena treatment with uterine gland myopathy / 中国实用护理杂志

Objective To explore the effect of medical cooperation health education after conservative surgery placed Mirena treatment with uterine gland myopathy.Methods 30 patients were collected and divided into general group and cooperation group by random number table method,with each group including 15 cases.General group accepted regular health education,while cooperation group received medical cooperation health education.6 months of home visits and telephone follow-up of two groups,statistical comparisons of menstruation,menstrual days,life satisfaction,adverse symptoms and satisfaction of diseases,Mirena,nursing methods between the two groups before and after the treatment.Results Patients' satisfaction and disease knowledge,Mirena knowledge,nursing knowledge the cooperation group scored higher than the conventional group (x2=2.184-6.184,P ＜0.05 or 0.01);the number of higher anxiety level was lower than the conventional group (x2=13.258,P ＜ 0.05);after treatment,dysmenorrhea severity score,menstrual flow,menstrual days,the quality of life the cooperation group were (0.35±0.08) points,(14.20±16.54) ml,(4.21±1.14) d,(9.01±1.36) points while the conventional group were (1.37±0.34) points,(39.64±8.62) ml,(6.74±1.07) d,(7.81±1.30) points,and the difference was statistically significant (t =2.47-11.31,P ＜0.01).the number of adverse symptoms of cooperation group was lower than that of the conventional group (x2=13.594,P ＜ 0.01).Conclusions Compared with single health education,cooperative medical health education has more advantage after conservative surgery placed Mirena treatment uterine gland myopathy which should be promoted in clinic.

Clinical Observation of Wenyang Huayu Sanjie Decoction in Treating Adenomyosis with Syndrome of Blood Deficiency and Cold Stagnation / 广州中医药大学学报

Objective To observe the therapeutic effect of Wenyang Huayu Sanjie Decoction ( WHSD) for the treatment of adenomyosis with the syndrome of blood deficiency and cold stagnation. Methods Seventy qualified patients were evenly randomized into observation group and control group. The control group was treated with Mirena intrauterine contraceptive device, and the observation group was treated with WHSD ( composed of Danggui Sini San, Wuzhuyu Shengjiang Tang, Shixiao San and Rhizoma Sparganii, Rhizoma Curcumae). The clinical outcomes included the menstrual blood volume, menstrual cycle, menstruation, degrees of dysmenorrhea, uterine volume, and serum CA125 level in the two groups before treatment and 3, 6 months after treatment. Results ( 1) After treatment for 6 months, the total effective rate of the observation group was 94.29%, significantly higher than 85.71% in the control group ( P<0.05). ( 2) After treatment, dysmenorrheal degrees, menstrual blood volume, menstrual cycle, menstruation, uterine volume, and serum CA125 level were improved in both groups ( P<0.05) , and the observation group had better effect on relieving dysmenorrhea, improving menstruation, and decreasing CA125 level than the control group ( P<0.05). ( 3) No obvious adverse reaction was found in the observation group, but most of the cases in the control group had menstrual disorder such as vaginal irregular bleeding and prolongation of menstruation. Conclusion WHSD has certain therapeutic effect on adenomyosis with the syndrome of blood deficiency and cold stagnation, and can also obviously improve the quality of life of the patients.

5 años de Experiencia en la Utilización del Dispositivo Intrauterino liberador de Levonorgestrel / 5 years of experience in the use of the levonorgestrel-releasing intrauterine device

Objetivo: Determinar el índice de éxito y los factores asociados en el uso del dispositivo intrauterino liberador de levonorgestrel (DIU-LVN). Materiales y Métodos: Estudio prospectivo, analítico experimental. Se recogieron datos de las pacientes ingresadas en el Servicio de Ginecología del HCIPS de febrero del 2007 a febrero del 2012 que se colocaron DIU-LVN y se realizo seguimientoa través del consultas ambulatorias. Resultados: Un total de 190 casos fueron seleccionados de forma aleatoria de 440. 60 casos fueron realizados en los años 2007 y 2008 sin evaluación histeroscopica de la cavidad endometrial 380 casos en los años 2009, 2010 y 2011 con evaluación histeroscopica, no considerando aptas para colocación pacientes con miomas submucosos irresecables. Edad de colocación: media de 42,9 años. Motivos: 92,6% HUA (61,6% miomas, 9,5% submucosos). Patologías asociadas: 31,1% HTA, 23,7% Diabetes Mellitus (DM), 34,2% Hipotiroidismo, 7,9% Hipotiroidismo y DM asociados 2,6% Anticoaguladas, 2,6% Endometriosis. Considerando la posición del útero, la situación de RVF resulto en un RR de 0,75, (IC: 0,41-1,38) y P: 0,33. La presencia de miomas en las pacientes que mantienen su SIU-LVN registró un RR de 1,26 (IC: 0,82-2,95) y una P: 0,28; comparando el IMC, las que presentaron IMC mayor a 25 obtuvo un RR 1,6 (IC: 0, 72-1,87) con P: 0,5. La presencia de hipertensión resulto un RR 1,14 (IC: 0,74-1,74) con P: 0,55. 37,4% con HSC previa. Hallazgos: 8,4% miomas submucosos y 3,7% pólipos endometriales. 76,8% tenían biopsia endometrial previa: 12,1% con hiperplasia endometrial simple sin atipias, 4,2% pólipo endometrial y el 60,5% normal. La histerometría a la colocación: promedio 9 cm. 70,6% mantienen su dispositivo, 3,2% con descenso y recolocación del mismo dispositivo por histeroscopía, 19,4% expulsó el dispositivo y 10% se retiró voluntariamente. De las que no mantienen su SIU-LVN 15,8% tuvieron una histerectomía, 2,6% se recoloco por segunda vez luego de una expulsión (todas mantienen su dispositivo), 2,6% fueron sometidas a una miomectomia por histeroscopía, 4,2% cambiaron a ACO, 3,7% entraron en menopausia, y 68,9% abandonaron tratamiento. Una tasa de éxito total del 76,3%, desglosada por año, éxito: 2007-2008 del 25%, 2009 del 69,5%, 2010 del 72% y 2011 Conclusión: Consideramos que estos dispositivos constituyen una opción más segura y de menor costo, con un buen índice de éxito, y una gran aceptación por parte de las pacientes y evita someterlas a procedimientos quirúrgicos mayores. Una evaluación histeroscópica previa a la colocación del dispositivo permite una mejor selección de las pacientes para colocación del dispositivo mejorando su tasa de éxito global. Aunque el dispositivo haya sido expulsado espontáneamente o se encuentre descendido, una segunda colocación o una reubicación por histeroscopía ha demostrado excelentes resultados. Palabras Claves: Dispositivo intrauterino, levonorgestrel, Mirena

Objective: To determine the success rate and associated factors in the use of levonorgestrel-releasing intrauterine system (LVN-RIS). Materials and Methods: Prospective study. 190 cases were selected at random for study from 440 to who the SIU-LVN where applied in the Gynecology Service of the HCIPS from February 2007 to February. Two groups where created: one with supposed high risk of failure of the treatment and one group with supposed high chances of success. The monitoring was done through the outpatient visits. Results: A total of 190 cases were selected at random from 440. 60 cases were performed in 2007 and 2008 without hysteroscopic evaluation of the endometrial cavity 380 cases in 2009, 2010 and 2011 with hysteroscopic evaluation, considered not suitable for LVN-RIS patients with unresectable submucosal fibroids. Placement age: mean 42.9 years. Diagnosis: HUA 92.6% (61.6% fibroids, submucosal 9.5%). Associated diseases: hypertension 31.1%, 23.7% diabetes mellitus (DM), hypothyroidism 34.2%, 7.9% hypothyroidism and 2.6% associated DM anticoagulated, 2.6% endometriosis. Considering the position of the uterus, the situation of RVF resulted in an RR of 0.75 (CI: 0.41 to 1.38) and P: 0.33. The presence of fibroids in patients who maintain their LVN-IUS showed a RR of 1.26 (CI: 0.82 to 2.95) and P: 0.28, comparing BMI, who had BMI greater than 25 RR was 1.6 (CI: 0, 72 to 1.87) with Q: 0.5. The presence of hypertension resulted RR 1.14 (CI: 0.74 to 1.74) with P = 0.55. 37.4% with previous HSC. Findings: 8.4% and 3.7% submucosal fibroids endometrial polyps. 76.8% had prior endometrial biopsy: 12.1% with simple endometrial hyperplasia without atypia, endometrial polyp 4.2% and 60.5% normal results. Hysterometry: mean of 9 cm. Patients who maintain their LVN-RIS: 70.6%, 3.2% with descended device and repositioning of the same by hysteroscopy, 19.4% expelled the device and 10% withdrew voluntarily. Of those who do not maintain their LVN-RIS 15.8% had a hysterectomy, 2.6% was repositioned for the second time after an expulsion (all keep their device), 2.6% underwent a myomectomy by hysteroscopy, 2% moved to oral contraceptives, 3.7% entered menopause, and 68.9% abandoned treatment. A total success rate of 76.3%. Success by year: 2007-2008: 25%; 2009: 69.5%; 2010: 72% and 2011: 83%. Conclusion: We believe that these devices are a safe and cheap treatment option, with a good success rate, and a high acceptance by patients, and avoid subjecting them to major surgical procedures. Hysteroscopic evaluation prior the placement of the device allows a better patient selection and improves its overall success rate. Even is this device descend or is expelled spontaneously, a second placement or relocation by hysteroscopy shows excellent results. Keywords: levonorgestrel releasing intrauterine system, Mirena

Utilidad del sistema intrauterino liberador de levonorgestrel (Mirena) en el tratamiento de las metrorragias / Usefulness of the Releasing Intrauterine System of Levonorgestrel in treatment of metrorrhagia

El uso continuo de anticonceptivos hormonales activos mediante la inserción del sistema intrauterino liberador de progestágenos (Levonorgestrel) ha sido de gran utilidad, pues además de la deseada acción anticonceptiva se le añade un efecto positivo de utilidad para el manejo de algunas afecciones ginecológicas, como son la endometriosis, fibromatosis uterina y ciertas disfunciones menstruales, a los que se han ido agregando recientemente nuevas indicaciones. OBJETIVO: Evaluar la utilidad del SIU liberador de Levonorgestrel (Mirena) en el manejo de las metrorragias y otras afecciones ginecológicas. MÉTODOS: Se realizó un estudio prospectivo, longitudinal, descriptivo que incluyó a 19 pacientes a las que se les insertó Mirena con el propósito de tratar las metrorragias y otras afecciones ginecológicas, en el período de tiempo comprendido entre el 1º de enero de 2003 al 31 de diciembre de 2008. Las pacientes incluidas en el estudio se evaluaron semestralmente mediante interrogatorio, examen clínico, estudios hematológicos y ecografía. RESULTADOS: Encontramos una notoria reducción del flujo menstrual, aquellas con más de 12 meses de uso presentaron un incremento de 1 ¢ gr en las cifras iniciales de hemoglobina. Las pacientes con miomas lograron discreta reducción tumoral y control de las metrorragias en tanto se comprobó una reducción en las masas quísticas y los síntomas en las pacientes con endometriosis, en tanto logramos un endometrio lineal en las pacientes en terapia de reemplazo hormonal (TRH). CONCLUSIONES: Los efectos adversos más reportados fueron los relacionados a la acción local del progestágeno sobre el endometrio como son el spotting y la amenorrea, de forma excepcional se reportaron calambres en miembros inferiores, hasta la fecha ninguna usuaria ha interrumpido la utilización de Mirena

The continuous use of active hormonal contraceptives by insertion of intrauterine system releaser of progestational agent (Levonorgestrel) has been very useful due to its desired contraceptive action as well as its positive effect for managing of some gynecological affections including endometriosis, uterine fibromatosis and certain menstrual dysfunctions and adding recently new indications. OBJECTIVE: To assess the usefulness of the intrauterine releaser system Lovenorgestrel (Mirena) in management of metrorrhagies and other gynecological affections. METHODS: A descriptive, longitudinal and prospective study was conducted including 19 patients underwent Mirena insertion to treatment metrorrhagies and other gynecological affections between January 1, 2003 and December 31, 2008. Patients included in study were half-yearly assessed by interviews, clinical examination, hematology studies and echography. RESULTS: There was a market reduction of menstrual flux; those patients with more than 12 months of use had an increase of 1 ¢ gr in first figures of hemoglobin. Patients presenting with myomata achieved a slight reduction of tumor and a metrorrhagies control also verifying a decrease in cystic masses and in symptoms of patients with endometriosis, while it was possible to obtain a linear endometrium in patients under hormone replacement therapy (HRT). CONCLUSIONS: More frequently reported adverse effects were those related to local action of progestogen on endometrium e.g. spotting and amenorrhea. As exception were the lower extremities cramps. Until now no patient has interrupted the use of Mirena

The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women / 부인종양

OBJECTIVE: Levonorgestrel releasing intrauterine system (LNG-IUS) has been shown to treat patients with non-atypical & atypical endometrial hyperplasia (EH) successfully in many western studies. Our purpose was to examine the effectiveness of LNG-IUS in the treatment of Korean women with EH. METHODS: We conducted a prospective observational study of 12 women diagnosed with EH and treated with LNG-IUS insertion between February 2007 and August 2009 at the Department of Gynecology of Gangnam CHA Hospital, CHA University School of Medicine. Baseline endometrial biopsies were done before insertion of LNG-IUS, and outpatient follow-up endometrial biopsies were undertaken at 3-month intervals after insertion of LNG-IUS. We investigated the regression rate and the time to regression. RESULTS: Four patients had simple hyperplasia without atypia, 7 patients complex hyperplasia without atypia, and just 1 patient complex atypical hyperplasia. Complete regression of EH was achieved in all cases (100%, 12/12), with the significant proportion (66%, 8/12) achieving it within 3 months. The mean duration to regression was 4.5 months. All cases had regression within 9 months. In the case of complex atypical hyperplasia, the regression was attained at the 9th month after insertion of LNG-IUS. The mean follow-up duration was 12 months (range, 3 to 27 months). As long as LNG-IUS was maintained, the EH did not recur. CONCLUSION: LNG-IUS appears to be as highly effective in treating Korean women with EH.

The usefulness of combined treatment of GnRH agonist and levonorgestrel-releasing intrauterine system (Mirena(R)) for chronic pelvic pain of endometriosis / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the effects of levonorgestrel-releasing intrauterine system (Mirena(R)) combination to GnRH (gonadotropin releasing hormone) agonist treatment on chronic pelvic pain of endometriosis, hypoestrogenic symptoms. METHODS: One hundred twenty eight patients who were diagnosed as endometriosis, were divided into endometriosis without adenomyosis group (n=88) and endometriosis with adenomyosis group (n=40). In 57 of 88 patients who had only endometriosis without adenomyosis, only GnRH agonist for 6 months was injected monthly (Group A). In the other 31 of 88 patients, Mirena(R) was inserted and GnRH agonist for 6 months was injected monthly (Group B). In 12 of 40 patients who had endometriosis and adenomyosis, only GnRH agonist for 6 months was injected monthly (Group C). In the other 28 of 40 patients, Mirena(R) was inserted and GnRH agonist for 6 months was injected monthly (Group D). The degree of pelvic pain, dysmenorrhe, and hypoestrogenic symptoms of each groups were observed and compared. RESULTS: The decreased pain rates of Group B and D were significantly higher than Group A and C (p<0.01), and decreased pain rates of Group D were significantly higher than Group B (p<0.05). The incidence of hot flush, depression and insomnia of 4 groups were not significantly different. CONCLUSIONS: Although Mirena(R) combination to GnRH agonist treatment cannot prevent the hypoestrogeic symptoms, Mirena(R) combination increases the treatment effect for pain of endometriosis. Especially, this effect is the more if adenomyosis is combined to endometriosis.

Clinical Efficacy of Levonorgestrel-Releasing Intrauterine System (Mirena(R)) for Abnormal Uterine Bleeding / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to study the clinical efficacy of Levonorgestrel-releasing intrauterine system (Mirena(R)) for patients who have abnormal uterine bleeding before menopause or sustaining vaginal spotting during postmenopaual hormone replacement therapy. METHODS: Between June, 2001 and June, 2003, forty six premenopausal women with abnormal uterine bleeding such as menorrhagia and intermenstrual bleeding who did not prefer surgical treatment (Group 1) and twenty four postmenopausal patients with vaginal spotting (Group 2) were included in this study. The various parameters such as uterine bleeding, dysmenorrhea, volume changes of myoma or adenomyosis, and endometrial thickness were evaluated by transvaginal ultrasound examination before and after Levonorgestrel- releasing intrauterine system usage. RESULTS: A significant reduction in abnormal bleeding (26.3 vs 11.0) (p<0.0001) and dysmenorrhea (11.6 vs 6.1) (p<0.0001) were noticed. However, there was no significant change in volume of uterine myoma (40.0 vs 11.3) (p=0.282) and adenomyosis (103.0 vs 95.83) (p=0.266) before and after Mirena(R) insertion in Group 1. Vaginal spotting during hormone replacement therapy disappeared completely in 18/24. Also there was a significant reduction in endometrial thickness (6.3 vs 4.9) (p<0.0001) after Mirena(R) insertion in both group 1 and group 2. CONCLUSION: Levonorgestrel-releasing intrauterine system insertion was acceptable and convenient therapeutic modality for abnormal uterine bleeding of premenopausal abnormal uterine bleeding and vaginal spotting during the postmenopausal hormone replacement therapy.