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.