Clinical Observation Of Levonorgestrel-releasing Intrauterine System On Adenomyosis

Objective:Adenomyosis is a common disease in gynecology. In recent years the incidence rate has been increasing and the incidence crowd gradually tends to be younger. The clinical manifestations of adenomyosis is mainly secondary and progressive dysmenorrhea accompanied with menorrhagia. That serious effect the quality of life in reproductive women. Drug treatment includes pseudo menopause therapy, pseudopregnant therapy can make the endometrial atrophy. Because there are many side effects of drugs, patients cannot adhere, and have poor compliance. If the medicine doesn’t work, patients with adenomyosis opt for hysterectomy. Although the operation treatment the curative effect is remarkable, but there are risks and complications, and the loss of blood supply for ovarian may have influence on ovarian function. It’s very important to choose a treatment of less side effects and less trauma. In the levonorgestrel-releasing intrauterine system(LNG-IUS; trade name:Mirena) levonorgestrel can release in the validity period of 5 years within the uterine cavity constant. Mirena have sustained long-term role in the treatment of adenomyosis, and then alleviate dysmenorrhea and reduce the amount of menstruation. The purpose of this paper is to guide the clinical treatments through observing the curative effects adverse reactions and satisfaction of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis.Materials and methods: During the period of 2013 January to 2014 June, there were 46 patients diagnosed adenomyosis. The visual analogue scale(VAS) is used to assess the degree of dysmenorrhea. Menstrual blood loss diagram(PBAC) is used to evaluate the menstrual quantity. Urinary distress inventory-6(UDI-6) is used to assess stress and irritative and obstructive symptoms.Before and at the 3, 6 months of LNG-IUS insertion,a observational study was conducted to observe the changes of the PBAC,VAS, HGB,CA125,UDI-6 and adverse reactions and the satisfaction. Statistical analysis was finished by the SPSS 19.0. Test for normality. If the data meet the normality, choose the t-test, and the data is represented by?x±s. If not, choose the Wilcoxon signed rank test, data are expressed as median M(P25,P75). P<0.05 was considered as statistically significant.Results: Of the all enrolled patients,1 patient were lost to follow-up and 1 patient discontinued the treatment because of expulsion after 2 weeks in the ring and 1 patient underwent hysterectomy because heavy uterine bleeding Lead to severe anemia.Overall,43 patients complete the 6-month follow-up, and this device were replaced for 4 patients because of the misplaced LNG-IUS. In addition, adverse reaction were observed in 43 patients after LNG-IUS insertion.1 Compared with before and at 3 and 6 months of the LNG-IUS insertion, the VAS of dysmenorrhea dropped obviously from the baseline score of 2(2,3)to 0(0,1),0(0,0),respectively.And the differences had statistical significance(P <0.01). The remission rate and cure rate of dysmenorrhea:①The symptoms of dysmenorrhea had relieved obviously at 3 months after the LNG-IUS insertion in 42 patients.That is, The total remission rate of dysmenorrhea was 97.67%( 42/43). The symptoms of dysmenorrhea completely disappeared in 22 patients(22/43,51.16%).②The symptoms of dysmenorrhea had relieved obviously at 6 months after the LNG-IUS insertion in 43 patients.That is, The total remission rate of dysmenorrhea was 100%(43/43).The symptoms of dysmenorrhea completely disappeared in 33 patients(33/43,76.74%).2 Menstrual blood loss(PBAC scores) and HGB: The PBAC scores decreased significantly from 216.70±47.10 to 74.63±16.38 at 3 months and to 49.26±22.27 at 6 months after the LNG-IUS insertion. The differences had statistical significance(P<0.01). The HGB of 18 anemia patients increase significantly from 109.80±6.23g/L to 118.70±6.94g/L at 3 months and to 126.14±6.65g/L at 6 months after the LNG-IUS insertion. The differences had statistical significance(P<0.01).3 The CA125 of all the patients decrease significantly from 65.35±11.37U/ml to 54.21±9.44U/ml at 3 months and to 47.04±8.19U/ml at 6 months after the LNG-IUS insertion. The differences had statistical significance(P<0.01).4 The UDI scores : At 6 months of the LNG-IUS insertion,UDI scores in 15 patients revealed improvement rates of 26.67%,13.33%,20.00% for irritative symptoms, strees symptoms, and obstructive symptoms, respectively. The differences in irritative symptoms and totel symptoms had statistical significance(P<0.05).5 Adverse reaction and satisfaction: The most common side effects was spotting. During the follow-up period 18 patients had vaginal spotting. The bleeding time lasted for 10 days to 20 days had amenorrhea at 6 months of the LNG-IUS insertion. The position of Mirena ring down in 4 patients accounted for 9.3%.One woman had expelled the LNG-IUS. 2 patients were discovered unilateral ovarian cysts during the follow-up process and the incidence was 4.65%. 2 patients accounted for 4.65%had breast distending pain at 3 months of the LNG-IUS insertion. 1 patient accounted for 2.32%had facial acneat 5 months of the LNG-IUS insertion. With a higher satisfaction, not satisfied numbers only accounted for 4.65%.Conclusion: Mirena used to treat adenomyosis although has side reactions, but have remarkable effect. Patient’s satisfaction was high.