Comparative Observation On The Clinical Efficacy Of GnRH-a Combined With LNG-IUS And Single Lng-ius In The Treatment Of Adenomyosis

Background and ObjectiveAdenomyosis is the invasion of endometrial glands and stroma into the myometrium,accompanied by hypertrophy and proliferation of myometrium cells,it is a common gynecological disease.Adenomyosis can be manifested as uterine enlargement,menorrhagia,progressive dysmenorrhea and other symptoms.This disease brings great pain to patients and seriously affects their quality of life.Currently,the commonly used treatment methods in China can still be divided into three categories: operative treatment,systemic drug treatment,and local treatment.However,each treatment has its own advantages and limitations.In recent years,the intrauterine sustained release system of levonorgestrel(LNG-IUS)has attracted wide attention as a new conservative treatment for adenomyosis.But the enlarged uterus in patients with adenomyosis,leading to a high rate of deannulus.Besides,irregular vaginal bleeding and other adverse reactions often occur after the upper ring,leading to the limited usement of this treatment.GnRH-a is a gonadotropin-releasing hormone,and is a neurohormone which is secreted by the hypothalamus.The development of adenomyosis can be controlled by inhibiting the hormone level of the ovary,thereby eliminating the stimulation of estrogen to the endometrium,and can reduce the adenomyosis lesions effectively.This study compared the clinical data of GnRH-a combined with LNG-IUS and LNG-IUS alone in the treatment of patients with adenomyosis,evaluated the clinical efficacy and adverse reactions of two conservative treatment schemes,and explored the method that can better alleviate the pain of patients with adenomyosis.MethodsThere were 217 patients with uterine adenomyosis who received intrauterine placement of mirena in our hospital were selected as research objects from July 2015 to May 2017.Among them,97 cases were treated with GnRH-a combined with LNG-IUS,and 120 cases were treated with LNG-IUS alone.Telephone follow-up investigation was conducted 1 year after super-ring,and dysmenorrhea(VAS score),menstrual volume(blood loss map)and uterine volume before and after treatment were recorded in detail,as well as irregular bleeding time,rate of ring removal and discomfort symptoms after treatment.Results1.Before treatment,there was no significant difference in age,uterine size,menstrual volume and dysmenorrhea score between GnRH-combined with LNG-IUS and single LNG-IUS groups(P>0.05);2.The total effective rate(90.72%)of GnRH-a combined with LNG-IUS was significantly higher than that of single LNG-IUS(84.17%),and the difference was statistically significant(P<0.05);3.After treatment,the uterine volume,menstrual volume and dysmenorrhea in the combined treatment group and the monotherapy group were significantly lower than before treatment,the differences were statistically significant(P<0.05).After treatment,the dysmenorrhea,menstrual volume and uterine volume in the combined group were significantly lower than those in the monotherapy group,the difference was statistically significant(P<0.05);4.After treatment,the irregular vaginal bleeding in the combined treatment group lasted for 0~3 months(23.71%),4~6 months(22.68%),and >6 months(9.28%)respectively.In the monotherapy group,the duration of irregular bleeding was 0~3 months(39.17%),4~6 months(22.50%)and >6 months(10.83%).There was no significant difference in the duration of irregular vaginal bleeding >6 months between the combined treatment group and the single treatment group(P>0.05);5.In the two groups,the rate of annulus deannulus was 10.31% in the combined group and 20.83% in the single group.The rate of annulus deannulus in the combined treatment group was significantly lower than that in the single treatment group,the difference was statistically significant(P<0.05).Conclusions1.GnRH-a combined with LNG-IUS and single LNG-IUS treatment can effectively improve the clinical symptoms of patients with adenomyosis;2.GnRH-a combined with LNG-IUS can increase the clinical efficacy and reduce the rate of deannulus,thus expanding the application of Mirena in adenomyosis.