A Clinical Observation Of Therapeutic Effect Of Levonorgestre-releasing Intrauterine System In Non-contraceptive For47Women

Objective:To observe a clinical of therapeutic effect of levonorgestrel-releasing intrauterinesystem in non-contraceptive, and to offer the new treatment thoughts for the patients ofadenomyosis，dysfunctional uterine bleeding（including simple type and complex typeendometrial hyperplasia).Materials and methods:Form September2012to January2014the data of47females saw a doctor in thesecond Hospital of Jilin University, and due to treating inserted LNG-IUS in out-patientoperating room were researched. Among29cases were diagnosed adenomyosis accordingto clinical symptoms, gynecologic examination and color doppler ultrasound;18caseswere diagnosed anovulatory dysfunctional uterine bleeding excluding reproductive organsand systemic, organic diseases,4cases with simple type endometrial hyperplasia and2cases with complex type endometrial hyperplasia through diagnostic curettage.Examination method was paired t test by itself. The changes of PBAC scores, verbal ratingscale (VRS), uterine volume and hemoglobin by taking out peripheral blood were observedbefore and3,6,12months after the place of LNG-IUS among adenomyosis patients. Thechanges of menstrual condition (including menstrual blood volume, menstrual cycle andmenstrual period) and the endometrial thickness (two endometrial thickness measured bytransvaginal color Doppler ultrasound) were observed before and3,6,12months after theplace of LNG-IUS among dysfunctional uterine bleeding patients.6cases with simpletype and complex type endometrial hyperplasia conducted diagnostic curettage again after6months laying up LNG-IUS, for observing the pathology pattern outcome. Meanwhile theside effect, such as the irregular bleeding, lower abdomen or lower back pain and gainweights was observed3,6,12months after the place of LNG-IUS. Results:1、Of the29cases with adenomyosis placed the LNG-IUS,4patients were lost orasked for removing it. One of them was not lost when he placed again, another threequitting continuing. PBAC scores and VRS scores of the other26cases with adenomyosiskept declining3months,6months and12months after the place of LNG-IUS and thedifference was statistically significant (P<0.01) compared with that before the place ofLNG-IUS. The level of hemoglobin of the patients kept recovering3months,6months and12months after the place of LNG-IUS and the difference was statistically significant(P<0.05) compared with that before the place of LNG-IUS. The uterine volume (cm3)slightly reduced3months,6months after the place of LNG-IUS and the difference was notsignificant; the uterine volume reduced from (306.20±75.56)cm3before the place to(230.60±49.93)cm312months after the place and the difference was significant(P<0.05).2、Of the18cases with anovulatory dysfunctional uterine bleeding（including simpletype and complex type endometrial hyperplasia) placed the LNG-IUS, one of them was lostcompanying menstrual blood, because of high amount of bleeding undergoing surgery todrop out the study. PBAC scores and endometrial thickness(mm) of the other17casesdeclined from127.20±18.94、14.20±3.49to107.00±14.40、9.60±2.193months after theplace of LNG-IUS respectively, the differences were statistically significant (P<0.01)compared with that before the place of LNG-IUS. The menstrual period was shortenedobviously12months after the place of LNG-IUS in contrast with that before and thedifference was significant (P<0.01). The difference of menstrual cycle was not statisticallysignificant before and3,6,12months after the place of LNG-IUS. Otherwise6cases withsimple type and complex type endometrial hyperplasia conducted diagnostic curettage6months after the place of LNG-IUS. Pathological examination indicated that endometrialhyperplasia regressed and exhibited visible secretion and interstitial decidual reaction.3、The main side effects were abnormal vaginal bleeding, lower abdomen or lowerback pain, ring down or ring off, ovarian cyst after the place of LNG-IUS. Minoritypatients were oligomenorrhea or amenorrhea. Several patients appeared endocrinesymptoms such as gain weights, acne, spot and breast distending. Conclusion:The patients with adenomyosis after using LNG-IUS could alleviate dysmenorrheaapparently, reduce menstrual blood volume, decrease uterine volume and increase the levelof hemoglobin. The patients with anovulatory dysfunctional uterine bleeding not onlyreduced menstrual blood volume but also decreased endometrial thickness. The menstrualperiod also decreased gradually and cured the endometrial hyperplasia as placing theLNG-IUS. Application of LNG-IUS can not only decrease the rate of the surgery but alsomaintain the reproductive function. It is a safety, effective and convenient method to treatdiseases for the majority of females. In addition, there were some side effects such asabnormal vaginal bleeding, lower abdomen or lower back pain, ring down, amenorrhea andendocrine symptoms.