A retrospective case control study to assess the outcome of pregnancy after large loop excision of the transformation zone of cervix (LLETZ) was carried out. One hundred and nineteen women who had undergone LLETZ and delivered in Basildon District Hospital were identified between January 1995 and December 1998; 119 age- and parity-matched controls were selected. Variables included were miscarriages, preterm deliveries, gestation at delivery, onset of labour, length of labour, augmentation of labour, mode of delivery and birth weight. The miscarriage rate in the study and control group were 11.8% and 9.2%, respectively (P=0.53). The preterm delivery rate in the study and control group were 10.9% and 9.2%, respectively (P=0.67). There were fewer caesarean sections and more spontaneous vaginal deliveries in the study group. There were slightly more instrumental deliveries in the study group. From this study, it was concluded that LLETZ does not appear to have an adverse effect on the outcome of pregnancy.

Objective. To review the literature on usage of the levonorgestrel intrauterine system (LNG IUS) An observational study and isolated reports of women with adenomyosis report significant symptomatic relief in these women. Conclusion. Available data refute the notion that uterine enlargement is a contraindication to insertion of the LNG IUS, but there appear to be reasons for a cautious approach when dealing with pathological uteri. IntroductionThe levonorgestrel intrauterine system (LNG IUS: Mirena ® , Schering, UK) is a highly effective contraceptive 1 and is extremely helpful in treating menorrhagia 2 among other confirmed or highly suggestive non-contraceptive benefits. 3 Randomised trials have confirmed its superior efficacy when compared with conventional medical treatment for menorrhagia 4 and its comparability with hysteroscopic surgical ablation of the endometrium. 5 Its advantages over endometrial ablation are: relative simplicity as well as reversibility, contraceptive effect 6 and the relief of pelvic pain. 7 The latter is frequently of even greater importance to the woman herself and is seldom relieved by, for example, transcervical resection of the endometrium (TCRE). 8 Recently published studies suggest the potential of the IUS to reduce hysterectomy waiting lists, 9,10 and it is generally accepted as a first option in women with heavy periods who also require contraception.Available information on the LNG IUS as a treatment for menorrhagia is mainly derived from studies of carefully selected women with dysfunctional uterine bleeding in research settings. However, in routine clinical practice, heavy menstrual loss is often due to underlying uterine pathology, most commonly fibroids and adenomyosis. It is therefore important to consider the possible effect of these conditions on the efficacy of the device and with this in mind, the available literature was reviewed. Effect of uterine fibroidsUterine myomas (fibroids) are benign tumours, which primarily contain smooth muscle, but may have varying densities of fibrous elements. Postmortem studies suggest that up to 50% of all women have fibroids 11 and that these are commonly associated with heavy menstrual loss. 12 This means practitioners who use the LNG IUS will undoubtedly encounter fibroids on a regular basis. Significant enlargement or distortion of uterine cavities, as well as excessive bleeding secondary to fibroids, can potentially affect the positioning of the device and hence efficacy.In addressing this issue, one also has to consider the possible effect of the released progestogen (levonorgestrel) on existing fibroids. This is a controversial subject as in vitro 13 and some clinical studies 14 have suggested a stimulatory effect in certain circumstances of some progestogens on uterine fibroids. Long-term contraceptive studies, however, have demonstrated protection from the complications of fibroids in association with use of depotmedroxyprogesterone acetate (DMPA) 15 and the LNG IUS 7 . Intramuscular DMPA causes moderately high sy...