Treatment of heavy menstrual bleeding associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

Abstract

Heavy menstrual bleeding is an increasingly common health problem. The levonorgestrel-releasing intrauterine system (LNG-IUS) has been advocated for the treatment of heavy menstrual bleeding as an alternative 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 heavy menstrual bleeding in the presence of uterine leiomyomas. This study included 68 patients with history of heavy menstrual bleeding and ultrasound-proved submucous uterine leiomyoma. Uterine bleeding was done by the semiquantitative pictorial blood loss assessment score. The 5-dimensional EuroQol was chosen as the primary measure of effectiveness on healthrelated quality of life. Patients were re-evaluated at 3, 6, 9, and 12 month. After 12 months of follow-up, a significant reduction of menstrual flow was observed up to amenorrhea (in 11 cases). No significant effect for the LNG-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 ten cases. Eight cases required removal of the IUS for different reasons. So this study shows that in selected cases of uterine leiomyomas, Mirena 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.

Levonorgestrel intrauterine contraceptive device in heavy menstrual bleeding: our experience in a tertiary level government hospital

“…In contrast to this, Magal Haes et al found significant change in leiomyoma volume after 3 years. [14][15][16][17] Patients with anovulatory cycles suffer from loss of progesterone effect on the endometrium leading to proliferation of endometrium due to unopposed action of estrogen. Also, the recent theory suggests that the absence of progesterone results in reduced endometrial stromal cell factor, reduced plasminogen activator inhibitor-1 production, increased matrix metalloproteinase activity and increased angiogenic factor expression.…”

Symptoms, diagnosis and treatment of submucous fibroids

“…Several studies show no significant effect or a significant but small effect on fibroid volume. (Magalhaes et al 2007;Shawki et al 2009;Socolov et al 2011;Tasci et al 2009;Xie et al 2012; Lopez-Olmos 2016)…”