A Clinical Observation Of Therapeutic Effect Of Levonorgestrel-releasing Intrauterine System For 45 Women

At present, the contraceptives which are used widely in China mainly include: IUD, contraceptive drugs and condoms. IUD and the contraceptive drugs have had continuous development and have been combined together. Scholars found that the progesterone IUD not only had good effect on contraception, but also help the menstruation recovery well and had no side effect on pregnancy after being removed Due to efficient progesterone, IUD could also be used in excessive menstration, dysfunctional uterine bleeding, adenomyosis .and got satisfied curative effect. The mainly used IUD in China is LNG-IUS.Objective: To explore the clinical efficacy and safety of levonorgestrel- releasing intrauterine system through clinical analysis and follow-up observation of 45 cases using LNG-IUS.Materials and methods: Form January 2009 to December 2010, the data of 45 females treated in the First Hospital of Jilin University, the Dongfeng County Hospital, Panshi City Hospital and Dehui City Hospital and laid up LNG-IUS in out-patient operating room were analyzed through Paired T test by itself. The changes of menstruation, endometrial thickness(measured by transvaginal color Doppler ultrasound of obstetrics and gynecology department one week before menstruation), uterine volume and dysmenorrhea VAS score were observed before and 3, 6, 12 months after the place of LNG-IUS. The side effect, such as the irregular bleeding and spotting was observed 3, 6, 12 months after the place of LNG-IUS and a comprehensive assessment of degree of satisfaction about LNG-IUS was made after it was placed.Results:1. Of the 45 cases placed the LNG-IUS, 2 patients with uterine adenomyosis were lost during the follow-up 3 months later. 2 patients' LNG-IUS fall off itself in the 2nd and 3rd month after being placed respectively, of which one case with uterine adenomyosis fell into pregnancy unintended due to the fall off of LNG-IUS and was placed LNG-IUS again as soon as the termination of pregnancy, the other case with uterine adenomyosis,dysmenorrhea improved afte she placed LNG-IUS,but she felt dysmenorrhea increased after 3 months .So she checked by transvaginal color Doppler ultrasound of obstetrics and gynecology department.She found the LNG-IUS was lost. She was placed LNG-IUS again after the fall off of LNG-IUS was found.Therefore, changes in menstruation of 43 cases were under the follow-up observation before and after the place of LNG-IUS.⑴Changes in menstrual cycle: the difference was not statistically significant(P>0.05) before and 3, 6, 12 months after the place of LNG-IUS.⑵Changes in menstrual period: the menstrual period was shortened obviously 12 months after the place of LNG-IUS and the difference was significant (t=5.52, P<0.0001) in contrast with that before the place of LNG-IUS.⑶Changes in menstrual blood volume: the menstrual blood volume of 43 patients kept declining after the place of LNG-IUS and the difference was statistically significant(P<0.0001)compared with that before the place of LNG-IUS. Amenorrhea phenomenon took place among three patients 3-12 months after the place of LNG-IUS.⑷the endometrium was significantly thinner 6 months after the place of LNG-IUS and remained meager 12 months after that. The difference was statistically significant(P<0.0001) before and after the place of LNG-IUS. 2. Dysmenorrhea VAS score in patients with adenomyosis declined significantly after the place of LNG-IUS, among which the most obvious decline happened 3 months after the place with the scores declined from (77.13±16.89) points before the place to (24.66±18.33) points after the place. The differences was statistically significant(t=10.04,P<0.001). The uterine volume reduced from (119.53±45.9) ml before the place to (81.98±29.37) ml 12 months after the place and the difference was significant(t=3.43,P<0. 01). 3. There was side effect in 29 cases (67.44%) after the place of LNG-IUS, such as vaginal spotting, irregular bleeding, prolonged menstrual and so on. There was abdominal bearing-down pain in 6 cases (14.0%) after the place, amenorrhea in 3 cases (7.0%) 3 months after the place and oligomenorrhea in 4 cases (9.3%) 6 months after the place. The IUD of 2 cases fell off with the menstrual blood 2 months and 3 months after the place respectively. 1 case did not pay attention to the fall off of IUD until she was found to be pregnant measured by transvaginal color Doppler ultrasound after menopause more than a month. There was not pregnancy unintended in other 42 cases over 12 months after the place. Benign ovarian cystic mass was found in 3 cases (7.0%). 4. The overall satisfaction rate (including very satisfied and satisfied) of the follow-up 43 patients 3, 6, 12 months after the place of LNG-IUS were 60.46%, 65.12% and 74.42% respectively. And the dissatisfaction rate were 9.31%, 6.97% and 4.65% respectively. None of the patients was very dissatisfied with the use of LNG-IUS.Conclusion: 1. LNG-IUS can ameliorate the moderate and severe dysmenorrhea and reduce the volume of uterus and the menstrual blood volume in patients with adenomyosis. Meanwhile, it can improve the menstrual blood volume in patients with dysfunctional uterine bleeding and has good therapeutic effect especially for menstrual disorders occurring during perimenopausal period, which greatly reduce the surgical treatments for these diseases mentioned above. Application of LNG-IUS can retain the reproductive function and control the symptoms effectively. In addition, it can be placed simply and accepted easily by the majority of females. It is a intrauterine contraceptive system safe and effective, of good contraceptive effect and convenient and economical. 2. There are many non-contraceptive benefits about the LNG-IUS. But there may be some side effect in the initial stage after being placed, such as irregular bleeding, spotting, abdominal bearing-down pain and so on. In addition, there may be oligomenorrhea, menstrual disorders and even menopause after long-term use and such side effect can be made better use of for the treatment of uterine bleeding during perimenopausal. 3.Illustrate the common side effect to the user before LNG-IUS is placed can increase the continuation rate and satisfaction level of LNG-IUS.