Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection

Istre, Olav; Trolle, Birgitta

doi:10.1016/s0015-0282(01)01909-4

Cited by 89 publications

(49 citation statements)

References 12 publications

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“…Studies comparing intrauterine hormonal treatment and endometrial resection have given similar results for the 12-month follow-up period [19,20]. In the present study 50 (17.9%) women had used a levonorgestrel-releasing intrauterine system prior to endometrial resection.…”

Section: Discussionsupporting

confidence: 65%

Long-term impact and risk factors for hysterectomy after hysteroscopic surgery for menorrhagia

2006

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The objective of this study was to assess the long-term impact of management and establish the incidence of hysterectomy, and to identify factors predictive of failure of the procedure among women who had undergone hysteroscopic endometrial resection with or without myomectomy for menorrhagia. Clinical history and data on additional treatment and follow-up status were obtained by medical record review and postal questionnaire for 279 women who had undergone hysteroscopic surgery. Followup data were available for 259 (93%) cases, and the mean follow-up was 6.0 years. Subsequent hysterectomy was the primary endpoint, and its incidence was calculated by survival analysis. Univariant analysis and Cox regression model were used to identify predictors of failure. Myomas, polyps, adenomyosis, or endometrial hyperplasia were found in 40.9% of hysteroscopic procedures. Perioperative complications occurred in 5.7% and late complications in 7.7%. During the follow-up period, 97 (37.5%) of 259 women underwent at least one gynecological procedure. The incidence of hysterectomy was 23.6% (95% confidence interval: 18.8-29.1%). Positive predictive factors for hysterectomy were long uterine cavity (≥9 cm) and tubal ligation. Most (82.8%) of the 198 women who did not undergo hysterectomy had postoperative oligo-or amenorrhea. Hormone replacement therapy was common (67%) among postmenopausal women after endometrial resection. Hysteroscopic resection of the endometrium and concomitant hysteroscopic resection of fibroids for the treatment of menorrhagia is a suitable alternative to hysterectomy and offers lasting results. A large uterine cavity indicating possible uterine pathology and tubal ligation associated with hematometra increase the risk of hysterectomy.

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Section: Discussionsupporting

confidence: 65%

Long-term impact and risk factors for hysterectomy after hysteroscopic surgery for menorrhagia

2006

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“…Eleven women (16.2%) were amenorrheic at 12 months. Other authors reported figures between 69% and 90% reduction of menstrual flow measured by PBAC [19][20][21][22][23][24][25]. Similar results were reported by Hickey and Farquhar [26], where in women with ovulatory dysfunctional uterine bleeding, Mirena system has been shown to produce an 86% reduction in objectively measured menstrual blood loss at 3 months and a 97% reduction at 12 months, with amenorrhea in 50% of women at 12 months.…”

Section: Discussionsupporting

confidence: 74%

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

et al. 2009

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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.

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“…Além disso, há uma publicação na qual o ganho de peso não foi observado ao longo de 12 meses de seguimento em usuárias de SIU-LNG e no grupo de mulheres que foram submetidas a ablação endometrial por menorragia. A média de idade dessas mulheres neste estudo foi de 41,4 anos no grupo de usuárias de SIU-LNG e 42,1 anos no outro grupo, mais velhas, por essa razão diferente do grupo de usuárias de SIU-LNG para contracepção 25 . O SIU-LNG está aprovado para o uso em muitos países do mundo tanto como método contraceptivo, mas também para o tratamento da menorragia ou como protetor endometrial durante a terapia de reposição hormonal 27 .…”

Section: Discussionunclassified

Variação de peso em usuárias de sistema intra-uterino liberador de levonorgestrel, DIU T-cobre e acetato de medroxiprogesterona no Brasil

Yela¹,

Monteiro²,

Bahamondes³

et al. 2006

Rev. Assoc. Med. Bras.

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RESUMOOBJETIVO. Determinar a variação de peso corpóreo em mulheres usuárias de sistema intra-uterino liberador de 20 µg/dia de levonorgestrel (SIU-LNG, Mirena®) e compará-la com a variação de peso de usuárias de dispositivo intra-uterino T cobre 380A (DIU Tcu) e usuárias de acetato de medroxiprogesterona de depósito (AMP-D) ao longo de cinco anos. MÉTODOS. Foram analisadas 163 mulheres usuárias de SIU-LNG que tiveram a inserção do mesmo em 1998 durante a admissão para o estudo. Cada mulher foi pareada por peso (± 1kg) e por idade (± 1 ano) no início do estudo, com as usuárias de DIU Tcu e AMP-D. Todas as mulheres foram seguidas por até cinco anos. Nesse período foram medidos seus pesos e calculados os índices de massa corpórea (IMC). RESULTADOS. A média de idade das usuárias de SIU-LNG foi 27±6,7 anos, enquanto que das usuárias de DIU Tcu foi 28±6,6 anos e das usuárias de AMP-D foi de 26,9±6,5 anos. O peso inicial era 62,9 ± 0,8 kg, 62,8 ± 0,8 kg e 62,5 ± 0,9 kg para as usuárias de SIU-LNG, DIU Tcu e AMP-D, respectivamente. O IMC no início do estudo era 25 (±0,3), 26,4 (±0,3) e 25,5 (±0,4) para as usuárias de SIU-LNG, DIU Tcu e AMP-D, respectivamente. Foi observado um aumento de peso de 3,1 kg, 4,9 kg e 8,2 kg para as usuárias de SIU-LNG, DIU Tcu e AMP-D, respectivamente, ao final do quinto ano (p=0,009). O IMC também apresentou um aumento em todos os grupos (IMC final de 26,3 ± 0,7, 28,5 ± 0,8 e 28,7 ± 1,3 para as usuárias de SIU-LNG, DIU Tcu e AMP-D, respectivamente). A análise multivariada mostrou que o uso de AMP-D e seu tempo de uso foram significativos em relação ao ganho de peso. CONCLUSÃO. O uso de SIU-LNG não mostrou aumento significativo no ganho de peso ao longo dos cinco anos, bem como diferença na variação de peso quando comparado com o uso de DIU Tcu. UNITERMOS: Peso. Sistema intra-uterino de levonorgestrel. Índice de massa corpórea.

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Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection

Cited by 89 publications

References 12 publications

Long-term impact and risk factors for hysterectomy after hysteroscopic surgery for menorrhagia

Long-term impact and risk factors for hysterectomy after hysteroscopic surgery for menorrhagia

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

Variação de peso em usuárias de sistema intra-uterino liberador de levonorgestrel, DIU T-cobre e acetato de medroxiprogesterona no Brasil

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