Modified Fixation of Levonorgestrel-releasing Intrauterine System for the Treatment of Adenomyosis / 中山大学学报(医学科学版)

ObjectiveTo introduce a fixation technique with the modified levonorgestrel-releasing intrauterine system （LNG-IUS） and evaluate its efficacy in the treatment of adenomyosis patients with previous LNG-IUS expulsion. MethodsA retrospective analysis was done on 22 adenomyosis patients who underwent modified LNG-IUS fixation due to LNG-IUS expulsion at three hospitals from June 2022 to June 2023. The baseline clinical characteristics， operative and postoperative details were collected and analyzed. The Visual analogu scale （VAS） scores and pictorial blood loss assessment chart （PBAC） scores were measured and compared before， 3 and 6 months after the LNG-IUS fixation. ResultsThe mean operative time was （19.51±7.41） min and intraoperative bleeding was （6.71±5.30） mL. Of the patients， 13 were operated under local anaesthesia and the other 9 under intravenous anaesthesia. There were 4 operations performed by a resident doctor， 15 by an attending doctor and 3 by a senior doctor. No intraoperative or postoperative complication was found. The mean follow-up was 11.51 months and no patient had a recurrence of LNG-IUS expulsion during the follow-up period. The mean level of hemoglobin at 1 month after operation was significantly higher than that before （P<0.001）. VAS scores and PBAC scores at 3 and 6 months postoperatively were all improved significantly than those preoperatively （P<0.001）. ConclusionsEffectively preventing the recurrence of LNG-IUS expulsion， modified LNG-IUS fixation is a safe and efficient method for adenomyosis patients with previous LNG-IUS expulsion. Modified LNG-IUS fixation deserves the clinical application due to its easy operation and wide range of use on women.

Evaluation of the efficacy of levonorgestrel intrauterine system in the management of heavy menstrual bleeding: An analytical observational study

Background: Heavy menstrual bleeding (HMB) poses threat to the quality of life among women. To prevent HMB, the levonorgestrel-releasing intrauterine system (LNG-IUS) is a well-known nonsurgical, long-performing, and alternative method. Objectives: The objective of this study was to determine the efficacy of LNG-IUS in women with HMB through an analytical observational study. Materials and Methods: This study was performed among 60 patients who visited the gynecology and obstetrics outpatient department (OPD) at the Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital (IPGMER and SSKMH), Kolkata, West Bengal, India from May 2019 to April 2020 due to HMB. The mean demographic and clinical profiles were evaluated, and comparative analysis was performed for hemoglobin (Hb), spotting, pain, and endometrial thickness on day 0 and follow-up 3 months, 6 months, and 12 months. Results: The mean age of patients was 37.77 ± 4.58 years was obtained. The Hb level was significantly (P < .001) increased, whereas pictorial blood loss assessment chart (PBAC) score, endometrial thickness, spotting, and pain were significantly (P < .01 and P < .001) reduced. The majority of patients had pallor, but the rates of spontaneous expulsion and hysterectomy were observed lower after using LNG-IUS among studied patients. Conclusion: the usage of LNG-IUS is potential in the treatment of HMB in women, which may lead to a better quality of life. This can be the alternative to hysterectomy and oral pills for long-term use. It is suggested in a future study with larger sample size and multicentric approach to minimize hospital biasness.

Role of LNG-IUS in adenomyosis in reproductive age group women: a prospective interventional study

Background: The objective of the present study was to observe the efficacy of LNG-IUS in the treatment of heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis.Methods: LNG-IUS was inserted in forty women between 20-50 years of age presenting with heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis diagnosed on transvaginal ultrasonography and followed up after 1 month, 3 months and 6 months of insertion. Subjective assessment of menstrual blood loss was done by pictorial blood loss assessment chart and dysmenorrhoea was assessed on the basis of universal pain assessment tool and side effects were noted at each visit.Results: Mean patients’ age was between 31-40 years (72.5%) and the follow up duration was 6 months. Significant improvements in dysmenorrhea, HMB and haemoglobin levels were observed. There was no significant change in the uterine volume. The most common side effect was prolonged vaginal spotting (n=26, 65%) and pain abdomen (n=13, 32.5%). LNG-IUS expulsion was observed in 1 patient (n=1, 2.5%). 3 patients underwent hysterectomy (n=3, 7.5%). The overall success rate of LNG-IUS was 82.5%.Conclusions: The LNG-IUS appears to be an effective method in alleviating dysmenorrhoea and heavy menstrual bleeding associated with adenomyosis during 6 months of study. It may be a valuable long-term alternative for the treatment of adenomyosis in young and perimenopausal women and it is a good strategy to reduce the number of hysterectomies in women with adenomyosis.

Impact of levonorgestrel intrauterine system on metabolic parameters

Background: Hormonal contraceptive is suggested to affect parameters like body mass index, body weight, blood pressure (BP), blood sugar, lipid protein, and liver function test (LFT) but effect of LNG-IUS on those parameters is still uncertain. The aim of the present study was to study the effects of LNG-IUS on the metabolic parameters.Methods: Sixty women who opted for LNG-IUS for various indications were included in the study. Lipid profile, liver function tests (LFT), glucose levels [fasting and post prandial (PP)], and hemoglobin (Hb) were tested. Bimanual genital examination and transvaginal-ultrasonography was done prior to LNG-IUS insertion. Any problems observed were recorded. The subjects were re-evaluated after 6 and 9 months on their subsequent visits. Data were analyzed using paired “t” test. P value of <0.05 was considered statistically significant.Results: Mean age of the patients was 35.5±6.79 years. Maximum number 50 (83.3%) had abnormal uterine bleeding (ovulatory dysfunction, endometrial, iatrogenic, not yet classified) [AUB (OEIN)]. Mean pictorial blood loss assessment chart (PBAC) score of patients was 164.7±56.72 and mean Hb level 11.15±1.75g/dL. LNG-IUS showed no significant adverse effects on anthropometric parameters at 6- and 9-month follow-up. Significant change was seen in total cholesterol (TC), very low-density lipoprotein (VLDL) and high density lipoproteins (HDL) values at follow-up (p<0.0001).Conclusions: In conclusion, amongst Asian population, the LNG-IUS does not have any adverse effects on metabolic parameters, TGs, LDL and blood sugar levels.

Clinical analysis of GnRH-a combined with LNG-IUS in the treatment of adenomyosis by different uterine volume / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effect of different uterine volume on the therapeutic effect of GnRH-a combined with levonorgestrel-releasing intrauterine system(LNG-IUS)in the treatment of adenomyosis.METHODS: From July 2014 to December 2017 in Center of Minimally Invasive Gynecology,Beijing Obstetrics and Gynecology Hospital,160 patients with adenomyosis were divided into experimental group and control group according to the volume of uterine cavity before inserting LNG-IUS.The experimental group(n=80)was inserted LNG-IUS when the uterine volume ≥100 cm~3.The control group(n=80)was inserted LNG-IUS when the uterine volume0.05).(3)The fall-off rate and LNG-IUS drop rate in the experimental group were higher than those in the control group(The fall-off rate was 15.0% and 5.0% in the two groups,P=0.035.The LNG-IUS drop rate was 25.0% and 12.5% in the two groups,P=0.043).(4)The uterine volume,the depth of uterine cavity and the amount of menstruation before insertion were risk factors which affected the fall-off/drop rate of LNG-IUS.When the uterine volume was greater than 97.33 cm~3,the prediction sensitivity was 96.0% and the specificity was 58.3%.When the depth of uterine cavity was greater than 8.75 cm,the prediction sensitivity was 92.0% and the specificity was 53.3%.CONCLUSION: Excessive uterine volume affects the efficacy of LNG-IUS in the treatment of adenomyosis.When the uterine volume is greater than 97.33 cm~3,or the depth of uterine cavity is greater than 8.75 cm before placement of LNG-IUS,the fall-off/drop rate is significantly increased.

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.

Clinical effect of MR-guided high intensity focused ultrasound and gonadotropin releasing hormone agonist combined with levonorgestrel-releasing intrauterine system in the treatment of recurrent uterine fibroids / 中国综合临床

Objective To explore the clinical effects of magnetic resonance guided high intensity focused ultrasound ( MRgHIFU ) and gonadotropin releasing hormone agonist ( GnRH-a ) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent uterine fibroids. Methods Eighty patients of recurrent uterine fibroids from April 2015 to June2017 in the First Hospital of Harbin were collected and randomly divided into the observation group and control group. MRgHIFU was used in the observation group were employed,and patients in the control group were treated with ING-IUS after first injecting GnRH-a. The tumor volume,hemoglobin level,menstrual quantity and adverse reactions were compared before and at 3 months,6 months after treatment. Results After 6 months,the size of the uterine myoma in the observation group was ((80. 23 ± 4. 35) cm3 ),significantly lower than that of the control group (( 135. 46 ±9. 25) cm3 ),and the difference was statistically significant ( t = 6. 01,P < 0. 05) . At 3 and 6 months after treatment,the amount of menstruation in the observation group was significantly lower than that of the control group( (66. 37 ± 12. 12) points vs. (40. 46 ± 10. 15) points; (98. 42 ± 14. 12) points vs. ( 68. 26 ± 11. 38) points). The difference was statistically significant (t at 3 months after treatment= 4. 52,P<0. 05,t at 6 months after treatment= 3. 53,P<0. 05). After 6 months of treatment,the hemoglobin value of the observation group was significantly higher than that of the control group (( 142. 12 ± 4. 24) g/ L vs. ( 108. 27 ± 3. 09) g/ L), the difference was statistically significant (t= 5. 02,P<0. 05),while the adverse reactions such as vaginal bleeding, hot flashes and night sweats were lower than those of the control group (2. 5% (1/ 40) vs. 7. 5% (3/ 40)) (χ2= 3. 99,P<0. 05). Conclusion Magnetic resonance guided high intensity focused ultrasound was considered as safe and effective in treating uterine fibroids,which is a new and noninvasive therapeutic methed,

Sistema intrauterino liberador de levonorgestrel en el tratamiento del sangrado uterino anormal secundario a miomatosis uterina / Levonorgestrel-releasing intrauterine system in the treatment of abnormal uterine bleeding secondary to uterine leiomyomas

Resumen ANTECEDENTES: el sangrado uterino anormal por miomatosis intramural de pequeños elementos es una indicación frecuente de histerectomía; el tratamiento hormonal puede disminuir la necesidad de esta cirugía. OBJETIVO: evaluar si con el sistema liberador de levonorgestrel disminuye el sangrado uterino anormal por miomatosis intramural de pequeños elementos. MATERIALES Y MÉTODOS: ensayo clínico fase II de un solo brazo al que se incluyeron mujeres de 35 a 45 años de edad, con diagnóstico de sangrado uterino anormal por miomatosis intramural de pequeños elementos, con útero menor a 12 cm (eje longitudinal por ultrasonido) y biopsia de endometrio sin enfermedad maligna; a todas se les colocó el sistema liberador de levonorgestrel. Se evaluó: el sangrado con la escala PBACs (Pictorial Blood Assessment Chart score), el dolor pélvico con escala de EVA, la recuperación hematológica (hemoglobina sérica), volumen uterino (mm3) y recuperación de la actividad física y sexual antes de la colocación del sistema liberador de levonorgestrel y a los 3, 6 y 9 meses posteriores. RESULTADOS: se estudiaron 20 pacientes, de éstas 3 con histerectomía antes de cumplir los tres meses de seguimiento. A los tres meses 76.4% (IC 95%: 55.9-97) redujeron el sangrado en más de 50% del basal, a los seis meses todas habían reducido más de 50% el sangrado y a los nueve meses, nueve eran amenorreicas, el resto con reducción promedio de 90%. El dolor se redujo y permitió recuperar la actividad física y sexual en 90% de los casos. Las concentraciones de hemoglobina se incrementaron, en promedio, 0.8 g/dL, y no hubo reducción clínicamente significativa del tamaño uterino. CONCLUSIONES: el sistema liberador de levonorgestrel disminuyó de manera muy significativa el sangrado uterino anormal por miomatosis intramural de pequeños elementos a partir de los tres meses de tratamiento.

Abstract BACKGROUND: abnormal uterine bleeding due to small intramural leiomyomas is a frequent indication of hysterectomy; hormone treatment may decrease the need for this surgery. OBJECTIVE: to evaluate if using the levonorgestreal-releasing system decreases abnormal uterine bleeding caused by small intramural leiomyomas. MATERIALS AND METHODS: a phase II single arm clinical trial that included women from 35 to 45 years with a diagnosis of abnormal uterine bleeding caused by small intramural leiomyomas in less than 12 cm uteri (longitudinal axis on ultrasound) and endometrial biopsy with no malignant disease; all the women had the levonorgestrel-releasing system placed. We evaluated: bleeding with the PBAC scale (Pictorial Blood Assessment Chart score), pelvic pain with the EVA scale, hematological recovery (serum hemoglobin), uterine volume (mm3) and recovery of physical and sexual activity before placement of the levonorgestrel-releasing system 3, 6 and 9 months later. RESULTS: 20 patients were studied, 3 of these had a hysterectomy before the three month follow up period. After three months 76.4% % (IC 95%: 55.9-97) decreased bleeding more than 50% compared to baseline, after six months, all had decreased bleeding more than 50% and at nine months, nine had amenorrhea and the rest had an average reduction of 90%. Pain decreased and allowed them to recover physical and sexual activity in 90% of cases. Concentrations of hemoglobin increased an average of 0.8 g/dL and there was no clinically significant reduction of the uterine size. CONCLUSIONS: the levonorgestrel-releasing system significantly decreased abnormal uterine bleeding caused by small intramural leiomyomas after three months of treatment.

Prospective study of the treatment of adenomyosis by combining hysteroscopic transcervical resection of endometrium with levonorgestrel-releasing intrauterine system / 上海交通大学学报（医学版）

Objective · To explore the clinical application value of hysteroscopic transcervical resection of endometrium (TCRE) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods · A total of 112 cases of adenomyosis patients were divided randomly into the combination group and Mirena group. The combination group (56 cases) was treated by TCRE endometrium endometrial resection, assisted Mirena treatment after operation. Mirena group (56 cases) was treated by Mirena only. The follow-up lasted 36 months after treatment, including measures of the volumes of menstrual bleeding, hemoglobin levels, dysmenorrhea scores, uterine volume, serum CA125 levels and incidences of complications.Results · The median follow-up duration was 42 months, and the three-year follow-up rate was 73.21% for the combination group and 50% for the Mirena group. After surgery, the volumes of menstrual bleeding of patients in 3-36 months decreased significantly, with an increase in hemoglobin level and a decrease in serum CA215 level and dysmenorrhea scores. Compared with their situations before surgery, the difference was significant (P<0.05). A comparison of uterine volume before and after surgery showed that there is a significant decrease in the uterine volume in both groups in6-12 months after surgery (P<0.05).Twenty-four months after surgery, it shows thatthe combination group has a much more significant decrease in uterine volume [(171.3±34.8) mm3] than Mirena group [(213.7±38.6) mm3] (P<0.05). The hysterectomy rate in Mirena group was significantly higher than that in the combination group (12.50% vs 5.36%); the ring expulsion rate was 16.07% in Mirena group and 5.36% in the combination group, and the break through bleeding happeningrate was 8.93% in Mirena group and 3.57% in the combination group. After 36 months an irregular small amount of vaginal bleeding rate was 62.25% in Mirena group, while it was only 12.50% in the combination group. There was significant differencewhen comparing above indices between two groups (P<0.05). There was no obvious differences in most common side effects of both groups. Conclusion · HysteroscopicTCRE combined with Mirena reduces significantly the irregular menstrual bleeding caused by merely applying Mirena. It has a prominent clinical efficacy and can be an effective approach in treatment of adenomyosis.

Efficacy of the Levonorgestrel-releasing Intrauterine System to Prevent Recurrence of Endometriosis after Conservative Surgery / 中国医科大学学报

Objective To evaluate the efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the prevention of endometriosis recurrence after conservative surgery.Methods We enrolled patients with medium and severe endometriosis who underwent conservative surgical treatment.All patients were divided into 3 groups:group A in which the patients were administered with 3 cycles of gonadotropin-releasing hormone agonist (GnRH-a) 5 days postoperatively,group B in which the patients were administered with the LNG-IUS 5 days postoperatively,and group C in which the patients were administered with 3 cycles of GnRH-a 5 days postoperatively and the LNG-IUS on the day of the third GnRH-a injection.All patients were followed up at 3,6,12,and 24 months postoperatively.Dysmenorrhea relief was evaluated,and pelvic ultrasound and serum CA125 detection were performed.All treatment-related adverse reactions were recorded.Results Eighty-three patients were included with 21,29,and 33 in groups A,B,and C,respectively.The VAS scores in all 3 groups after 3 months were significantly lower than those obtained preoperatively (P ＜ 0.05).No significant difference was found in the VAS scores after 6 and 12 months among the 3 groups (P ＞ 0.05).After 24 months,the VAS scores in group A were significantly higher than those in the other 2 groups (P ＜ 0.05).Endometriosis recurrence was found in 8 patients after 24 months,with 4 (19.05％),3 (10.71％),and 1 (3.13％) such patient in groups A,B,and C,respectively (P ＜ 0.05).No serious side effects were found.Conclusion Postoperative application of LNG-IUS can effectively prevent recurrence and relieve pain caused by endometriosis,and its combined application with GnRH-a can improve efficacy.

Effect of Levonorgestrel Releasing Intrauterine System on Endometrial in Patients with Anovulatory Uter-ine Bleeding / 中国药师

Objective:To analyze the effect of levonorgestrel releasing intrauterine system ( Mirena) on endometrium in the pa-tients with anovulatory uterine bleeding. Methods:Totally 67 cases of anovulatory uterine hemorrhage were treated with Mirena. The menstrual blood volume, uterine endometrial thickness, hemoglobin, endometrial ET content and complications were recorded before and after the treatment. Results:After the 12-month treatment, the menstrual blood volume and endometrial thickness were significant-ly decreased, and hemoglobin was significantly increased (P<0. 01). The percentage of abnormal uterine bleeding was significantly decreased, the ET content in endometrium was significantly decreased (P<0.05), and the ET content was decreased significantly with the prolongation of the treatment time. The complication rate was reduced from 50. 74% to 7. 46%. Conclusion:Mirena is nota-bly effective in the treatment of the patients with anovulatory uterine bleeding.

Clinical observation on hysteroscopic transcervical resection of endometrium combined with levonorgestrel-re-leasing intrauterine system in treatment of adenomyosis / 局解手术学杂志

Objective To observe the effects of hysteroscopic transcervical resection of endometrium combined with levonorgestrel-relea-sing intrauterine system in the treatment of adenomyosis. Methods Clinical data of 62 cases with adenomyosis from January 2009 to January 2011 were randomly divided into 2 groups with 31 cases each. The observation group was given hysteroscopic transcervical resection of endo-metrium ( TCRE) combined with levonorgestrel-releasing intrauterine system( LNG-IUS) ,the control group was given LNG-IUS. All patients were followed up in 0,1,3,6,12 months after treatmenting with LNG-IUS. The menstrual blood volume,score of VAS,volume of uterus, CA125 and the levels of serum reproductive hormone were analyzed before treatment and after treatment. Results After the therapy,the cur-ative effects of controlling menorrhea were improved and the the observation group was significantly better than the control group(P0. 05). Conclusion It is exact effect to treat adenomyosis by TCRE combined with LNG-IUS,which can prevent dripping bleeding induced by application of LNG-IUS effectively.

Interventional treatment for adverse reactions caused by levonorgestrel releasing intrauterine system (LNG-IUS) in treating uterine adenomyosis / 医学研究生学报

Objective The adverse reactions of levonorgestrel releasing intrauterine system ( LNG-IUS) has been emphasized with the increase of its indications.The study was to investigate the feasibility of interventional treatment in treating uterine adenomyosis with LNG-IUS by observing its adverse reactions, trying to reduce its adverse reaction, increase its utilization ratio and service life and improve its efficacy. Methods Retrospective analysis was made on 67 patients with uterine adenomyosis who were willing to accept LNG-IUS treatment from January 2012 to December 2013 in our hospital.The patients were randomly divided into observation group ( n=34) and control group( n=34) according to different therapies.The observation group were given interventional treatment immedi-ately after the placement of LNG-IUS, that is to take oral non-steroidal anti-inflammatory drug ( indomethacin, 25 mg, 1 pill each time, three times a day) for 7 consecutive days and desogestrel-ethinylestradiol ( marvelon, 1 pill a day) for 21 consecutive 21 days, 3 con-secutive cycles;while the control group were only given communications without any special treatment.Observation and record were made on related adverse reactions at 1 month, 3 months and 6 months after the treatment. Results At 1 month, 3 months and 6 months after the interventional treatment, the incidence rates of abnormal uterine bleeding between two groups were of significant difference ( 23.5%vs 60.6%, 11.7%vs 36.4%, 0%vs 12.1%, P<0.05) in the control group. At 6 month after the treatment, statistical difference was found in the total incidence rates of amenorrhea, ovarian cysts, dislocation and out of place of IUD between these two groups ( 23.5%vs 6.1%, 2.9%vs 21.2%, 2.9%vs 18.2%, P<0.05). Conclusion The research has indicated that the adoption of interventional treatment after placing LNG-IUS can obviously reduce the occurrence of the main adverse reactions, so it is feasible in clinical application.

Therapy of heavy menstrual bleeding in Korea: Subanalysis and results from a multinational clinical trial in the Asian region investigating the levonorgestrel-releasing intrauterine system versus conventional therapy

OBJECTIVE: To compare real-life clinical outcomes with the levonorgestrel-releasing intrauterine system (LNG-IUS) and conventional medical therapies (CMTs), including combined oral contraceptives and oral progestins in the treatment of idiopathic heavy menstrual bleeding (HMB) in South Korea. METHODS: This prospective, observational cohort study recruited a total of 647 women aged 18 to 45 years, diagnosed with HMB from 8 countries in Asia, including 209 women from South Korea (LNG-IUS, 169; CMTs, 40), who were followed up to one year. The primary outcome was cumulative continuation rate (still treated with LNG-IUS and CMTs) at 12 months. Secondary outcomes included bleeding pattern, assessment of the treatment efficacy by treating physician and safety profile. RESULTS: The continuation rate at 12 months was significantly higher with the LNG-IUS than CMTs (85.1% vs. 48.5%, respectively; P<0.0001). The 51.5% of CMTs patients discontinued treatment and 18.8% of LNG-IUS patients discontinued treatment. The most common reasons for discontinuation for CMTs were switching to another treatment and personal reasons. When compared to CMTs, the LNG-IUS offered better reduction in subjectively assessed menstrual blood loss and the number of bleeding days, tolerability and with better efficacy in HMB, as assessed by physician's final evaluation. CONCLUSION: This study provides novel information on the real-life treatment patterns of HMB in South Korea. The efficacy of CMTs was inferior compared to the LNG-IUS in the clinical outcomes measured in this study. Due to the better compliance with LNG-IUS, the cumulative continuation rate is higher than CMTs. We conclude that the LNG-IUS should be used as the first-line treatment for HMB in Korean women, in line with international guidelines.

GnRHa therapy combined with Mirena for treatment of 70 cases of adenomyosis / 上海预防医学

combined with LNG-IUS) and control group ( n =36, treated by only LNG-IUS).After treatment were compared the improvement of uterine volume , dysmenorrhea and menorrhagia and other symptoms in the two groups. [Results] After treatment, the uterine volume, dysmenorrhea severity score and menstrual flow in observation group were significantly lower than those in control group ( P<0.05);during follow-up time, there occurred 7 cases(20.58%) of dripping vaginal bleeding and 4 cases(11.76%) of decyclization in control group , while in observation group there was none of occurrence . [ Conclusion ] GnRHa combined with LNG-IUS is of better clinical efficacy in the treatment of adenomyosis than LNG-IUS used alone.

Clinical research of oral contraceptive and levonorgestrel-releasing intrauterine system after hysteroscopic endometrial polypectomy in preventing recurrence / 中国医师进修杂志

Objective To explore the recurrence-prevention effect of oral contraceptive and levonorgestrel-releasing intrauterine system (Mirena) after hysteroscopic endometrial polypectomy.Methods One hundred and seventy-four patients who received hysteroscopic endometrial polypectomy were enrolled in this research.The patients were informed and divided into three groups according to their selection:51 cases were given oral contraceptive since one month until 12 months after the surgery (oral contraceptive group); 60 cases were received Mirena since one month after the surgery (Mirena group) ; and 64 cases were received no treatment after the surgery (control group).The groups were followed up at 3,6,12 months after the surgery and compared the recurrence rate,menstruation,level of hemoglobin and complication rate.Results The recurrence rate in oral contraceptive group,Mirena group and control group was 3.9％(2/51),3.3％ (2/60) and 19.0％ (12/63),respectively.The recurrence rate in control group was higher than that in oral contraceptive group and Mirena group,and there was significant difference (P ＜ 0.05).The proportion of low menstruation volume in control group was lower than that in oral contraceptive group and Mirena group,and there was significant difference (P ＜ 0.05).The level of hemoglobin in control group was lower than that in oral contraceptive group and Mirena group [(124.55 ±9.33) g/L vs.(133.71 ± 11.03),(135.89 ±6.88) g/L],and there was significant difference (P ＜ 0.05).The incidence of complication in Mirena group [18.3％ (11/60)] was less than that in oral contraceptive group[35.3％(18/51)],and there was significant difference (P ＜ 0.05).Conclusions Oral contraceptive and Mirena after hysteroscopy for endometrial polys significantly decrease the recurrence rate.The complication rate of Mirena is lower and it is a safe and effective way to treat and prevent the endometrial polyp.

The clinical application of levonorgestrel-releasing intrauterine system on the treatment of clinical analysis of adenomyosis / 中国综合临床

Objective To investigate the clinical effect of left tactic norgestrel releasing intrauterine system in the treatment of adenomyosis. Methods One hundred and thirty-four patients with diagnosis of uterine adenomyosis were selected as our subjects in Xuanwu Hospital of Capital Medical University from Mar. 2010 to Mar. 2013. They were randomly divided into control group(67 cases)and observation group(67 cases). Patients in control group were give Gestrinone with oral,and in observation group were give left acetylene connaught progesterone intrauterine placed treatment slow-release system. The information of pain scores,menstruation, uterine volume,endometrial thickness were recorded. Results After treatment,pain score,menstrual quantity, uterine volume and endometrial thickness in observation group were(1. 85 ± 0. 57),(45. 37 ± 11. 94)ml, (129. 47 ± 8. 67)mm3 ,(4. 02 ± 2. 04)mm,significantly lower than the control group((4. 82 ± 2. 07),(61. 47 ± 12. 07)ml,(148. 54 ± 12. 47)mm3 ,(6. 35 ± 2. 64)mm),and the differences between groups were statistically significant(t = 5. 397,6. 047,5. 334,4. 681 respectively;P < 0. 05). Conclusion The therapy of levonorgestrel releasing intrauterine system on treating adenomyosis of uterus is safe and effective. It is worthy of promotion.

Endometrial carcinoma in an asymptomatic patient using the levonorgestrel-releasing intrauterine system / 동물의과학연구지

The levonorgestrel-releasing intrauterine system (LNG-IUS) is used for contraception and treatment of heavy menstrual bleeding as well as endometrial hyperplasia and early endometrial carcinoma. A 48-year-old woman visited an Internal Medicine outpatient clinic due to significantly elevated CA-125 and CA-19-9 levels in a routine health examination. She had been using LNG-IUS for 3 years. Before LNG-IUS insertion, she suffered from heavy menstrual bleeding and severe dysmenorrhea. Her endometrial sampling and ultrasonographic imaging showed no evidence of endometrial carcinoma at the time of LNS-IUS insertion. After insertion, she complained of neither abnormal uterine bleeding nor dysmenorrhea. She received a routine health checkup every year and showed results within normal range until last year. To rule out pancreatic cancer due to significantly elevated CA-19-9 levels, her physician performed positron emission tomography-computed tomography, which demonstrated increased FDG uptake in the endometrial cavity. We obtained endometrial biopsy and found endometrial carcinoma in her uterus and performed radical hysterectomy with bilteral pelvic lymphadectomy. Permanent pathology confirmed endometrial carcinoma with lymph node metastasis. She received concurrent chemoradiation therapy. We emphasize the necessity of regular follow-ups with ultrasonography and assessment of serum tumor markers for the early detection of endometrial carcinoma, although rare, in women using LNG-IUS, including those without abnormal uterine bleeding.

The effect of levonorgestrel-releasing intrauterine system in ovarian endometriosis after laparoscopic operation / 中国医师进修杂志

Objective To discuss the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) in ovarian endometriosis after laparoscopic operation.Methods One hundred and fifty patients with ovarian endometriosis were treated by placement of LNG-IUS after laparoscopic operation (study group).The therapeutic effect and adverse reaction were observed.Fifty patients with ovarian endometriosis only treated by orally gestrinone were as control group.The rate of recurrence was compared.Results After placement of LNG-IUS for 3,6,12 months,the thickness of endometrium in study group was significantly thinner [(6.02 ± 1.84),(5.68 ± 1.38),(4.04 ± 1.24) mm vs.(7.85 ± 1.62) mm],the amount of menorrhea and the scores of visual analogue scale (VAS) was significantly decreased [(48.29 ± 7.04),(32.64 ± 6.09),(19.74 ± 4.78) ml vs.(65.63 ± 7.83) ml,(35.74 ± 16.34),(20.54 ± 12.29),(13.79 ± 10.38) scores vs.(78.13 ± 15.69) scores],there was significantly difference compared with that before treatment (P ＜ 0.05).After placement of LNG-IUS for 3 months,the menstrual period in study group was significandy longer than that before treatment [(9.42 ± 3.75) d vs.(6.69 ± 2.83) d],and after placement of LNG-IUS for 12 months,the menstrual period in study group [(4.53 ± 1.37) d] was significantly shorter than that before eatment (P ＜ 0.05).In study group,the menstrual cycle had no significant difference among different time point (P ＞0.05).In follow-up period,the adverse reaction in study group was mainly intermenstrual bleeding,and the rate of intermenstrual bleeding was gradually decreased (P ＜ 0.05).Others adverse reaction was rare,and the incidence rate was gradually decreased.The rate of recurrence in study group was significandy lower than that in control group [14.7％(22/150) vs.30.0％(15/50)](P＜0.05).Conclusion Placement of LNG-IUS after laparoscopic operation can reduce symptoms and signs,and can play important role in preventing recurrence.

Effect of myoma size on failure of thermal balloon ablation or levonorgestrel releasing intrauterine system treatment in women with menorrhagia

OBJECTIVE: The aim of the present study was to identify variables associated with treatment failure in women with menorrhagia who were treated with thermal balloon ablation (TBA) or levonorgestrel releasing intrauterine system (LNG-IUS), and to determine if there are subgroups where one treatment type is more effective than the other. METHODS: The study included 106 women with menorrhagia who were treated with TBA or LNG-IUS at the study institute between January 2003 and December 2007, with a follow-up period greater than 12 months. Data were collected by retrospective review of medical records. Treatment failure was defined as persistent or recurrent menorrhagia within one year after treatment or hysterectomy at any time during follow-up. The relationships between variables and treatment outcome were analyzed using the chi-square or Fisher's exact test. The treatment outcome of TBA was compared with LNG-IUS. RESULTS: Sixty-seven women were treated with TBA and 39 women were managed with LNG-IUS. Fifty-two women had a myoma > or =2.5 cm. Treatment failure was observed in 24 women (2 recurrent or persistent menorrhagia and 22 hysterectomies) and myoma size (> or =2.5 cm vs. <2.5 cm) was associated with treatment outcome. TBA and LNG-IUS showed similar treatment outcomes. CONCLUSION: A large myoma is a risk factor for treatment failure in women with menorrhagia treated with TBA or LNG-IUS.