Treatment of menorrhagia associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

ABSTRACT

Menorrhagia is an increasingly common health problem. The Icvonorgestrel-releasing intrauterine system [LNG-IUS] has been advocated for the treatment of menorrhagia as an alicrnativc to surgery. Based on this established indication and theoretical potential of targeted endometrial solution of myoma-related bleeding, we evaluated the efficiency of LNG-IUS in treating selected cases presenting with menorrhagia in the presence uicrinc leiomyomas. This study included 68 patients with history of menorrhagia and U/S proved submucous uterine leiomyoma. Uterine bleeding was done by the semiquantitative pictorial blood loss assessment score [PBAC]. The 5-Dimensional EuroQol [EQ-5D] was chosen as the primary measure of effectiveness on health-related quality of life. Patients were re-evaluated at 3,6,9 and 12 month. Alter 12 months of follow-up, a significant reduction of menstrual flow was observed up to amenorrhea [in 11 cases]. No significant effect for the ENG-IUS on the volume of fibroids or the uterine volume was observed. A significant improvement of the quality of life [measured by EQ index] was observed. Side effects were reported in 10 cases. Eight eases required removal of the IUD for different reasons. So this study shows that in selected cases of uterine leiomyomas, LNG-IUS is an effective therapy directed towards the local steroid environment of the endometrium for control of the bleeding with no valuable effect on the myomas themselves