A Study of the Effectiveness of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding (AUB) - The Need of the Hour
Abstract
Introduction: The incidence of heavy menstrual bleeding is 17.9% to 20% in India. The levonorgestrel intrauterine system (LNG-IUS) has been an effective treatment for any age group.
Aims and Objectives: 1. To know the improvement in menorrhagia after inserting LNG-IUS 2. To compare pretreatment menstrual cycles with post-LNG-IUS cycles 3. To assess the blood loss by PBAC scoring and haemoglobin
Materials And Methods: The study was done in a tertiary centre for a duration of three years. 50 women with abnormal uterine bleeding who fulfilled the inclusion criteria were enrolled in the study and their consent was obtained. History of participants was taken and general and systematic examinations were done along with ultrasonography. LNG-IUS was inserted after menstruation. PBAC score was calculated and compared with the previous cycles. Haemoglobin (Hb) estimation was done and the usefulness of LNG-IUS was noted.
Results: Out of 50 subjects, most were perimenopausal, multiparous women (72%). 36% had a bulky uterus. Endometrial thickness was > 9 mm in 8 women. Dilatation and curettage was done. PBAC score before treatment was 156-200 for 44% of the participants. After the treatment, the PBAC score decreased to 51-70 in 46% of the women. Maximum women used 21-25 pads per cycle before treatment. After treatment, most of the subjects used 10-15 pads per cycle. A decrease in dysmenorrhea was seen in 24% of women. A haemoglobin level of less than 8 gm% was seen in 36% of participants before the treatment. After LNG-IUS, haemoglobin improved by more than 1 gm% in 76% of women.
Conclusion: LNG-IUS is a good treatment for abnormal uterine bleeding. It is as effective as a hysterectomy in patients with dysfunctional uterine bleeding and can decrease the incidence of hysterectomies and the associated complications.
How to cite this article:
Vijayasree M. A Study of the Effectiveness of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding (AUB) - The Need of the Hour. Int J Adv Res Gynaecol Obstet. 2023;1(1):1-6.
References
Sharma A, Dogra Y. Trends of AUB in tertiary centre of Shimla hills. J Midlife Health. 2013;4(1):67-8. [PubMed] [Google Scholar]
Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3- 13. [PubMed] [Google Scholar]
Hidalgo MM, Hidalgo-Regina C, Bahamondes MV, Monteiro I, Petta CA, Bahamondes L. Serum levonorgestrel levels and endometrial thickness during extended use of the levonorgestrel-releasing intrauterine system. Contraception. 2009;80(1):84-9. [PubMed] [Google Scholar] 1.
Seeber B, Ziehr SC, Gschliesser A, Moser C, Mattle V, Seger C, Griesmacher A, Concin N, Concin H, Wildt L. Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system. Contraception. 2012;86(4):345-9. [PubMed] [Google Scholar]
Lethaby AE, Cooke I, Rees M. Progesterone or progesterone-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;(4):CD002126. [PubMed]
International Society of Gynaecological Pathologists (ISGP), World Health Organisation (WHO). Classification of endometrial hyperplasia. In: Kurman RJ, editor. Blaustein’s pathology of the female genital tract. 5th ed. New York: Springer-Verlag; 2002. p. 467- 500.
Endrikat J, Vilos G, Muysers C, Fortier M, Solomayer E, Lukkari-Lax E. The levonorgestrel-releasing intrauterine system provides a reliable, long-term treatment option for women with idiopathic menorrhagia. Arch Gynecol Obstet. 2012;285(1):117-21. [PubMed] [Google Scholar]
Kriplani A, Singh BM, Lal S, Agarwal N. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet. 2007;97(3):190-4. [PubMed] [Google Scholar]
Gunes M, Ozdegirmenci O, Kayikcioglu F, Haberal A, Kaplan M. The effect of levonorgestrel intrauterine system on uterine myomas: a 1-year follow-up study. J Minim Invasive Gynecol. 2008;15(6):735-8. [PubMed] [Google Scholar]
Xiao B, Wu SC, Chong J, Zeng T, Han LH, Luukkainen T. Therapeutic effects of the levonorgestrel-releasing intrauterine system in the treatment of idiopathic menorrhagia. Fertil Steril. 2003;79(4):963-9. [PubMed] [Google Scholar]
Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkilä A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol. 1998;105(6):592-8. [PubMed] [Google Scholar]
Lähteenmäki P, Haukkamaa M, Puolakka J, Riikonen U, Sainio S, Suvisaari J, Nilsson CG. Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. BMJ. 1998;316(7):1122- 6. [PubMed] [Google Scholar]
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