Clinical Study Of Levonorgestrel-releasing Intrauterine System In The Treatment Of Peri-menopausal Ovarian Dysfunction Uterine Bleeding(AUB-0)

Background Perimenopause is defined as a period of time before and after menopause,which is about 4-5 years.It is usually marked by the appearance of various physical symptoms.Among them,abnormal uterine bleeding is the most common,accounting for abnormal uterine bleeding in gynecological clinics.(AUB)About 70% of patients.Ovulation disorder is one of the main causes of abnormal menopausal uterus.It reflects the decline of ovarian storage and distribution function,and the decline of ovarian function makes it less reactive to FSH and LH,resulting in abnormality of hypothalamic pituitary ovary axis.,resulting in rare ovulation or anovulation,causing insufficient or no secretion of progesterone.This causes the endometrium to proliferate under the constant stimulation of estrogen resulting in abnormal uterine bleeding.It has a major impact on the health of patients and the quality of life.The main treatment options for perimenopausal ovarian dysfunction uterine bleeding(AUB-O)are hemostasis and adjustment cycles.Hemostasis method: 1 drug treatment to stop bleeding;2 curettage to stop bleeding is mainly suitable for long-term bleeding or severe anemia emergency hemostasis;3 surgical treatment as a diagnosis of scraping and conservative treatment(drug treatment)poor treatment of patients with alternative treatment,because of its trauma Large,complicated complications and high cost side effects limit their use in perimenopausal patients.Peri-menopausal AUB-O requires long-term management and the adjustment cycle is an important part of it.The perimenopausal cycle is long and the ovarian function continues to decline.Therefore,a persistent and constant progesterone is needed to protect the endometrium.The levonorgestrel intrauterine sustained release system(LNG-IUS)is a new and widely used intrauterine device that combines the convenience of intrauterine device placement,long treatment time and high efficiency of oral contraceptives.advantage.Local sustained-release levonorgestrel causes endometrial atrophy,interstitial edema and decidual changes,mucosal thinning,epithelial inactivity,no dividing phase,vascular inhibition,etc.,thereby resisting the effects of estrogen on the endometrium,reduce menstrual flow,adjust the menstrual cycle.With the large number of clinical applications of Mirena,there have been reports in the literature that the application of levonorgestrel sustained-release system within 12 months,some patients with peri-menopausal abnormal uterine bleeding have amenorrhea and other symptoms.There is no literature report on the correlation between the incidence of Mirena and vaginitis in the uterine cavity.This study compared the treatment of 68 cases of peri-menopausal AUB-O patients in the Zhengzhou University People's Hospital with Mirena intrauterine therapy and 62 cases of perimenopausal AUB-O patients treated with dydrogesterone.The effectiveness and safety of the Mirena IUD in patients with perimenopausal AUB-O(whether it affects ovarian function),compliance,and side effects.Purpose To investigate the efficacy,safety,compliance and quality of life improvement of the treatment of perimenopausal aub-o patients with mirena iud.Methods This study was a prospective study,in which 130 patients with perimenopause abnormal uterine bleeding were collected and randomly divided into the experimental group and the control group according to the order of patients' visit.Among them,68 patients in the experimental group were treated with mirena intrauterine device,and62 patients in the control group were treated with diprogesterone.The efficacy,safety,compliance and quality of life of perimenopausal aub-0 patients were compared and analyzed.Result There was no significant difference in age and disease course between the experimental group and the control group(P>0.05).The treatment effect of the experimental group was better than that of the control group.Before treatment,the difference between Hb and endometrial thickness in the two groups was statistically significant(P > 0.05).After treatment,Hb in the experimental group was significantly higher than that in the control group,and endometrial thickness was significantly lower than that in the control group,and the difference was statistically significant(P< 0.05).There was no significant difference in quality of life score between the experimental group and the control group before treatment(P > 0.05),and the difference in quality of life score between the experimental group and the control group after treatment was statistically significant(P < 0.05).There was no significant difference in the incidence of vaginitis between the two groups before and after treatment(P > 0.05).There was no significant difference in FSH and E2 between the two groups before and after treatment(P > 0.05).Irregular spotting or mild vaginal bleeding occurred in both groups 3-6 months after treatment,and the experimental group was more than the control group,and the difference was statistically significant(P < 0.05).The compliance of patients in the experimental group was significantly better than that in the control group.Conclusion1.The intrauterine placement of Mirena IUD is more effective than oral dydrogesterone in the treatment of peri-menopausal AUB-O patients. 2.There is no significant difference in the safety of peri-menopausal AUB-O in the treatment of peri-menopausal AUB-O in the uterus.3.Intrauterine placement of Mirena IUD for the treatment of peri-menopausal AUB-O patients was higher than oral dydrogesterone.4.Intrauterine placement of Mirena IUD for the treatment of peri-menopausal AUB-O patients with early adverse reactions(vaginitis incidence,vaginal bleeding)is higher than oral dydrogesterone.