| Objective: We treated adenomyosis patients of different uterine cavity depth by using variety gonadotropin-releasing hormone analogue(GnRH-a)treatment cycles,and observed the clinical efficacy,menstrual pattern,adverse reaction and compliance,so as to investigate the clinical value of GnRH-a combined with LNG–IUS on the treatment of uterine adenomyosis.Methods:One hundred and ten adenomyosis patients from September 2011 to September 2013 at Department of Obstetrics and Gynecology,the Forth Affiated Hospital of Nanchang University were recruited for the study.Fifty-eight patients whose uterine cavity depth below 9 cm were divided randomly into group A B C.While fifty-two patients whose uterine cavity depth from 9 to 12 cm were divided randomly into group D E F.The patients of group A B D E F received injections of GnRH-a every 28 days.Group A were inserted LNG-IUS following two courses of GnRH-a,while group B and D three courses,group E six courses.Group C were inserted LNG-IUS in 3 to 5 days of menstrual cycle.Group F received six courses of GnRH-a and did not insert LNG-IUS.Before the treatment,28 days after treatment of GnRH-a and six,twelve,eighteen,twenty-four months after the insertion of LNG-IUS or terminent of GnRH-a,we evaluated its clinical effect(visual analogue scale,uterine volume,endometrial thickness,CA125),adverse reaction and menstrual pattern.Results:1.The uterine volume of group A B D E F significant decreased after the treatment of GnRH-a(P<0.001).However,comparison between group A and B had no statistical significance(P>0.05).2.The reduction of uterine volume of group B and D was 24.9% and 51.1%,respectively.The reduction degree of uterine volume showed positive correlation after GnRH-a treatment(r=0.801,P<0.001).The reduction of uterine volume of group D and E was 51.1% and 59.0%,respectively,it showed that the shrinkage ofuterine volume occurred mainly in the first 12 weeks of GnRH-a treatment.3.The uterine volume of group A and B was smaller after twenty-four months of LNG-IUS insertion than before insertion(P<0.05).The uterine volume of group D and E was smaller after twenty-four months of LNG-IUS insertion than before GnRH-a treatment(P<0.001).The uterine volume of group F was significantly shrinked after six months of LNG-IUS insertion,and then it increased.In twenty-four follow-up period,the average of uterine volume was larger than group D and E.4.The uterine volume of group C decreased relatively slower than others,after twelve months of LNG-IUS insertion the uterine volume reached to minimum,and then it increased.In twenty-four follow-up period the average of uterine volume was larger than group A and B,while less than the level before treatment(P<0.001).5.The dysmenorrhea symptoms of group A B D E F improved significantly after the GnRH-a treatment(P<0.001).There was no recurrence in twenty-four months after combination with LNG-IUS.However,the VAS score of group C decreased slower than others,the dysmenorrhea symptoms relieved after six months insection of LNG-IUS,and in twenty-four follow-up period no one case relapsed.Dysmenorrhea symptoms of group F increased to moderate level followed up to twenty-four months.6.Forty patients were accepted in group E and F originally,while eight cases dropped out of therapy due to severe perimenopausal symptoms.The occurrence of perimenopause syndrome in group E and F was 86.7% and 88.2%,respectively,which was higher than group A B C D(0?15.0%?0?20.0%),P<0.01.The menstrual pattern of group A B C was mainly irregular vaginal bleeding.The bleeding time of group C after six months LNG-IUS insertion was 17.2±3.6 days,which was higher than group A and B,10.0±2.3 days and 8.5±1.7 days,respectively.Conclusion:1.GnRH-a combined with LNG-IUS could reach satisfactory clinical efficacy on the treatment of uterine adenomyosis than use GnRH-a or LNG-IUS alone.2.Two or three courses of GnRH-a treatment before LNG-IUS insertion was a effective and safe therapeutic schedule on the treatment of uterine adenomyosis. |
PDF Full Text Request