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Federación Mexicana de Ginecología y Obstetricia, A.C.

2017, Number 07

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Ginecol Obstet Mex 2017; 85 (07)

Levonorgestrel-releasing intrauterine system in the treatment of abnormal uterine bleeding secondary to uterine leiomyomas

Zavala-Chaparro E, Martínez-Uribe J, Rendón-Macías ME, González-Aldeco PM

Language: Spanish
References: 13
Page: 449-456
PDF size: 283.70 Kb.


ABSTRACT

Background: abnormal uterine bleeding due to small intramural leiomyomas is a frequent indication of hysterectomy; hormone treatment may decrease the need for this surgery.
Objetive: to evaluate if using the levonorgestreal-releasing system decreases abnormal uterine bleeding caused by small intramural leiomyomas.
Materials and Methods: a phase II single arm clinical trial that included women from 35 to 45 years with a diagnosis of abnormal uterine bleeding caused by small intramural leiomyomas in less than 12 cm uteri (longitudinal axis on ultrasound) and endometrial biopsy with no malignant disease; all the women had the levonorgestrel-releasing system placed. We evaluated: bleeding with the PBAC scale (Pictorial Blood Assessment Chart score), pelvic pain with the EVA scale, hematological recovery (serum hemoglobin), uterine volume (mm3) and recovery of physical and sexual activity before placement of the levonorgestrel-releasing system 3, 6 and 9 months later.
Results: 20 patients were studied, 3 of these had a hysterectomy before the three month follow up period. After three months 76.4% % (IC 95%: 55.9-97) decreased bleeding more than 50% compared to baseline, after six months, all had decreased bleeding more than 50% and at nine months, nine had amenorrhea and the rest had an average reduction of 90%. Pain decreased and allowed them to recover physical and sexual activity in 90% of cases. Concentrations of hemoglobin increased an average of 0.8 g/dL and there was no clinically significant reduction of the uterine size.
Conclusion: the levonorgestrel-releasing system significantly decreased abnormal uterine bleeding caused by small intramural leiomyomas after three months of treatment.


REFERENCES

  1. Banafsheh N, Kashani CG, Morelli SS, Gerson W, Petraglia F. Role of Medical Management for Uterine Leiomyomas. Best Practice & Research Clinical Obstetrics and Gynaecology 2016;34: 85-103.

  2. Marret AH, Fauconnier N, Chabbert-Buffet L, Cravello F, et al. Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010;152:133-137.

  3. Kriplani A, Divya A, Vidushi K, Nutan A. Efficacy of the levonorgestrel-releasing intrauterine system in uterine leiomyoma. International Journal of Gynecology and Obstetrics 2012;116:35-38.

  4. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health 2014;5:95-114.

  5. Levy G, Hill MJ, Beall S, Zarek SM, Segars JH, Catherino WH. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet 2012;29:703-712.

  6. Qing Xua, Lili Qiub, Liqun Zhub, Li Luob, Changfen Xub. Levonorgestrel inhibits proliferation and induces apoptosis in uterine leiomyoma cells. Contraception 2010;82:301-308.

  7. Muzeyyen G, Ozdegirmenci O, Kayikcioglu F, et al. The Effect of Levonorgestrel Intrauterine System on Uterine Myomas: A 1-Year Follow-up Study. Journal of Minimally Invasive Gynecology, 2008;15(6):735-738.

  8. Chantal B, Kamaria C, Cayton W, Farah S, et al. An Evidencebased Approach to the Medical Management of Fibroids: A Systematic Review. Clinical Obstetrics and Gynecology 59 (1):30-52.

  9. Mirena. Sistema intrauterino de liberación de levonorgestrel. Monografía del producto. México: Bayer Schering Pharma, 2010.

  10. López-Olmos J. Dispositivo intrauterino liberador de levonorgestrel (DIU Mirena®) y quistes de ovario. Clin Invest Gin Obst. 2012. http://dx.doi.org/10.1016/j. gine.2012.10.009 1

  11. Satu Heliövaara-Peippo, Ritva Hurskainen, Juha Teperi, Anna-Mari Aalto, et al. Quality of life and costs of levonorgestrel- releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial. American Journal of Obstetrics & Gynecology 2013;209(6):535.e1-535.e14.

  12. Jefferys A, Akande V. Modern management of fibroids. Obstetrics, Gynaecology and Reproductive Medicine 2016) http://dx.doi.org/10.1016/j.ogrm.2016.02.004

  13. Youm Jina, Ju Lee Hyun, Ki Kim Seul, Kim Hoon , Chul Jee Byung. Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system. International Journal of Gynecology and Obstetrics 2014;126:165-169.




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