Levonorgestrel-releasing intrauterine device use as an alternative to surgical therapy for uterine leiomyoma

Şenol, Tuncer; Kahramanoğlu, İhsan; Doğan, Yasemin; Baktiroğlu, Merve; Karateke, Atilla; Süer, Necdet

doi:10.12891/ceog1826.2015

Cited by 21 publications

(2 citation statements)

References 16 publications

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“…There is no evidence yet on what type of fibroids LNG-IUD act on long-term, thus avoiding surgery, and for which subtypes other treatment options should be primarily considered. Many studies show a significant drop-out rate of participants with no response to LNG-IUD, who require definitive treatment, i.e., a hysterectomy ( 28 , 29 ). No data on the effectiveness of lower doses of levonorgestrel are yet available.…”

Section: Medical Managementmentioning

confidence: 99%

Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding

Uimari

Subramaniam

Vollenhoven

et al. 2022

Front. Reprod. Health

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Uterine Fibroids, or leiomyomata, affect millions of women world-wide, with a high incidence of 75% within women of reproductive age. In ~30% of patients, uterine fibroids cause menorrhagia, or heavy menstrual bleeding, and more than half of the patients experience symptoms such as heavy menstrual bleeding, pelvic pain, or infertility. Treatment is symptomatic with limited options including hysterectomy as the most radical solution. The genetic foundations of uterine fibroid growth have been traced to somatic driver mutations (MED12, HMGA2, FH−/−, and COL4A5-A6). These also lead to downstream expression of angiogenic factors including IGF-1 and IGF-2, as opposed to the VEGF-driven mechanism found in the angiogenesis of hypoxic tumors. The resulting vasculature supplying the fibroid with nutrients and oxygen is highly irregular. Of particular interest is the formation of a pseudocapsule around intramural fibroids, a unique structure within tumor angiogenesis. These aberrations in vascular architecture and network could explain the heavy menstrual bleeding observed. However, other theories have been proposed such as venous trunks, or venous lakes caused by the blocking of normal blood flow by uterine fibroids, or the increased local action of vasoactive growth factors. Here, we review and discuss the evidence for the various hypotheses proposed.

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Section: Medical Managementmentioning

confidence: 99%

Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding

Uimari

Subramaniam

Vollenhoven

et al. 2022

Front. Reprod. Health

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“…In an RCT that included women with idiopathic HMB, the LNG-IUS was more effective than cyclical MPA given for 10 days starting from day 16 of the cycle. The LNG-IUS was linked to a greater absolute and percentage reduction in menstrual blood loss and a higher likelihood of success [ 125 ].…”

Section: Use In Abnormal Uterine Bleedingmentioning

confidence: 99%

Utility of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Abnormal Uterine Bleeding and Dysmenorrhea: A Narrative Review

Bianchi

Guo

Habiba

et al. 2022

JCM

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Introduction: We undertook a literature review of the use of levonorgestrel-releasing intrauterine devices when utilized for heavy menstrual bleeding and/or dysmenorrhea. Methods: A narrative review of articles in the Scopus and Medline databases was conducted. Results: A number of options exist for the management of both abnormal uterine bleeding (AUB) and dysmenorrhea, and evidence is accumulating that the insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) represents a useful option for their long-term treatment. The idea of using a progestogen released in utero was initially conceived to achieve long-term contraception, but it was quickly found that these systems could be utilized for a number of therapeutic applications. The first device to be made commercially available, Progestasert, was withdrawn from the market because, in the event of contraceptive failure, it caused a disproportionate percentage of extrauterine pregnancies. On the other hand, the LNG-IUS continues to be successfully utilized in its various variants, releasing 20, 13, or 8 μg/day. These devices have a respective duration of action of 7 (possibly 8), 5, and 3 years, and there exist versions of frameless systems affixed to the myometrium of the uterine fundus. In the present review, following a brief description of the major causes of AUB and dysmenorrhea, the molecular bases for the use of the LNG-IUS are summarized. This is followed by a compendium of its use in AUB and dysmenorrhea, concluding that the insertion of the system improves the quality of life, reduces menstrual blood loss better than other medical therapies, and decreases the extent of dysmenorrhea and pelvic pain. In addition, there is no evidence of a significant difference in these outcomes when the use of the LNG-IUS was compared with improvements offered by endometrial ablation or hysterectomy. Possibly, the most important mechanism of action of the system consists of its ability to induce amenorrhea, which effectively eliminates heavy bleeding and dysmenorrhea. However, no method is ideal for every woman, and, in the case of the LNG-IUS, younger age and severe dysmenorrhea seem to be associated with a higher risk of discontinuation. Conclusion: The higher-dose LNG-IUS is a useful tool for HMB and dysmenorrhea in women of all ages. The low cost and ease of use make the LNG-IUS an attractive option, especially when contraception is also desired.

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