Clinical Effects Of Intermittent Treatment With Mifepristone In Levonorgestrel-releasing Intrauterine System Implant Users

ObjectiveThe aim of this study was to investigate Clinical effects of intermittenttreatment with mifepristone in levonorgestrel-releasing intrauterinesystem implant users,and to evaluate the efficacy of mifepristone inreducing intermenstrual vaginal bleeding pattern.Materials and methods1. SamplesThis was a prospective double-blind, randomized trial performed atthe Guangzhou First Municipal People’s Hospital,which is the affiliatedhospital of Guangzhou medical college, from January2007to December2008.Atotal of38women who were diagnosed with adenomyosis(through clinicalsymptoms,boold serum CA125,B ultrasonic examination,Magnatic ResonanceImaging,laparoscopy,laparotomy) and using the LNG-IUS were randomlyassigned in to one of the two treatment groups.19women who receivedmifepristone orally100mg every30days for3months wre used as group A.Theother19uses who did not receive any drugs were used as the comparison group,group B.2. MethodsPictorial blood loss assessment chart(PBCA) scores,degree ofdysmenorrhea, boold serum CA125,serum sex hormone levels,endometrialthickness and uterine volume,menstrual bleeding days and intermenstrualbleeding/spotting days were compared between the2groups at3months(during treatment) and at6months(3months post treatment),12months(9months post treatment),24months(21months post treatment).3. Statistics analysisData were recorded asx±S. The results were analyzed by Student’st-test for independent means with SPSS13.0statistical software. P valuesof less than0.05were considered as statistical significance.Results1. Baseline characteristics were comparable between the groups. At3months, The number of women having intermenstrual spotting andduration of intermenstrual bleeding/spotting were significantly lowerin group A compared with group B (6vs13,6±3vs12±7days, P<0.05).At6months,these two observations had no significant differences werenoted.At12months and24months,the number of women havingintermenstrual spotting and duration of intermenstrualbleeding/spotting had dropped compared with3months and6months(P<0.05),but between these two group there had no significantdifferences(P>0.05).2. At3months,6months,12months,24months,a significant decrease in PBCAscores of all users were noted(P<0.05),but no significant differenceswere noted between2groups.（P>0.05）.3. At3months,menstrual bleeding days were significantly lower in2groupscompared with before LNG-IUS insertion(P<0.05). At6months, this difference was still significant lower in2groups compared with beforeLNG-IUS insertion and the3months’ condition.At12months and24months, this difference was still significant lower in2groups comparedwith before LNG-IUS insertion,the3months’ condition, the6months’condition(P<0.05).4. After LNG-IUS insertion,a significant decrease in VAS scores of all userswere noted(P<0.05),but there no significant differences were notedbetween2groups.（P>0.05）.5.①At3months, endometrial thickness were significantly thiner in groupA compared with group B (7.3±2.6mm vs8.8±2.9mm, P<0.05).Endometrialthickness was thiner in group A compared with before LNG-IUSinsertion(P<0.05),but there no significant differences was noted ingroup B(P>0.05).At6months, endometrial thickness were significantlythiner in group B （7.0±1.5mm） compared with the3months’condition(P<0.05), but there no significant differences were noted ingroup A（7.2±1.6mm）(P>0.05).At12months,24months, endometrialthickness were noted thiner,but there no significant differences werenoted between2groups.②A significant decrease in uterine volume was noted3months (P <0.05)and6months (P<0.05) after LNG-IUD insertion,slightly decrease wasnoted12months(P<0.05),and decrease after24months withoutsignificance(P>0.05).6. A significant decrease in boold serum CA125was noted at3months (P<0.05) and6months (P<0.05) after LNG-IUD insertion,slightly decreasewas noted12months(P<0.05),and decrease after24months withoutsignificance(P>0.05).7. The serum sex hormone levels no significant differences were notedbetween group A and group B.8. More women were satisfied with the LNG-IUS in the group A compared with the group B(15vs9; P<0.05).Conclusions1. For patients with clinical diagnosis of adenomyosis, the LNG-IUSis effective for the relief of dysmenorrhea,reduction of PBCA scoresand uterine volume,with improve quality of life and control symptomsprogression.LNG-IUS insertion is a kind of stability,ecomomic andconservative treatment for a adenomyosis.2. Mifepristone was effective in reducing the number of episodes andduration of intermenstrual bleeding/spotting in LNG-IUS users.3. These two methods were both effective in the treatment ofadenomyosis,but LNG-IUS insertion combine with mifepristone canimprove patients’ satisfaction.