Clinical Evaluation Of Levonorgestrel-releasing Intrauterine System For Treament Of Adenomyosis

Objective: To investigate the clinical evaluation of levonorgestrel releas-ing intrauterine system for treatment of adenomyosis.Methods: Select patients treated from January2009to March2012at theDepartment of obstetrics and gynecology of the second hospital of HebeiMedical University, Including outpatients and inpatients. According to thesymptoms such as dysmenorrhea, menstrual disorders, heavy menstrualbleeding, the increase of volume of uterus and other symptoms and signs,126patients were diagnosed as uterine adenomyosis. Then they were givenLNG-IUS and were followed up at the time of1,3,6,12,24,36monthspostoperativly to evaluate LNG-IUS' effect on menstruation, dysmenorrhea,endometrial changes and the level of hemoglobin.The data was presented as X±S, analyzed by method of paired-t testswith SPSS13.0software.Result: Before the administration of LNG-IUS, the average dysmenor-rhea scoring of the126patients was72±15, after3months of the insertionLNG-IUS, the score was22±17, the symptoms of dysmenorrhea wassignificantly relieved, there's significant difference statistically.(P＜0.01).Scoring of the menstrual volume: the menstrual volume of all patientssignificantly decreased after3,6,12,24,36months of LNG-IUS insertion,were (29±11)%,(13±6)%,(7±4)%,(2±0.3)%,(1.3±0.2)%, comparedwith that of the preinsertion, there are significant difference.(P＜0.01).Menstrual cycle: after6months of LNG-IUS, the period of menstrualcycle increased to(32±5)days from(30±4)days of pre-insertion. Menstrualperiod: at the early stage, the increase of menstrual period was observed,which presented as spotting bleeding and irregular bleeding.1months afteradministration, the period was(15.2±3.2)days,3months after administration, the average period is (10.4±2.6) days,6months is(5.6±1.9)days,12monthsdecreased to (3.0±1.1) days,24months is(1.9±0.2)days, and finally theperiod decreased to (1.4±0.3) days. At all, the menstrual period wassignificantly decreased, and there's significant difference statistically. Thechange of endometrial thickness: the average endometrial thickness was(17.9±4.94)mm before the administration of LNG-IUS.1,3,6,12,24,36months after the administration of LNG-IUS, the endometrial thicknesswere(11.95±1.56)mm,(9.3±1.3)mm,(6.1±2.4)mm,(4.8±1.5)mm,(4.1±1.1)mm,(3.8±1.23)mm respectively, all were decreased significantly andthere's difference statistically(P＜0.01). The change of uterine volume:12months after the insertion, the average uterine volume declined from the(142±42) cm3before the insertion to (129±26)cm3, there's significantdifference,(P＜0.05).24months after the insertion, the average uterinevolume was (112±19)cm3, and36months,(110±26)cm3. The change ofhemoglobin: The anemia of the58patients were corrected within the6monthsafter administration of LNG-IUS, the level of hemoglobin was recovered to(126±9.6)g/L from the (89.3±15.2)g/L before the administration. The rate ofcomplications: spotting bleeding(27.77%),oliqomenorrhea(19.84%),amenorrhea(6.34%), acne and alteration of vaginal secret (1.4%), loss rate(0.7%).Conclusion: LNG-IUS treatment for adenomyosis, can alleviatedysmenorrhea associated with adenomyosis significantly, decrease themenstrul blood loss, minimize the uterine volume and effectively prevent theprogression of adenomyosis while the complications are relatively rare.