Analysis Of 70 Cases Of Endometrial Polyps Treated With Mirena After Operation

Objective To summarize the clinical characters who use levonorgestrel-releasing intrauterine system(LNG-IUS)after transcervical resection of polyps(TCRP).Investigate the changes of menstrual pattern and the occurrence of other adverse reactions,understand the satisfaction and concerns of patients,so as to improve the compliance of patients,and provide consultation and help for future clinical work.Method Retrospective analysis and telephone follow-up were performed on 70premenopausal women who underwent TCRP to preventrecurrence in our hospital from January 2016 to December 2019.The characteristics of related cases and adverse reactions to changes in menstrual pattern and patient satisfaction were summarized.Results:No recurrence of endometrial polyps was observed in the ultrasonographic follow-up of using mirena after TCRP,and endometrial thickness was significantly thinner than that before TCRP(P<0.05),the mean endometrial thickness before operation was 11.61±3.56mm,and the mean endometrial thickness after operation was5.12±1.31mm;The degree of dysmenorrhea in 23 patients with dysmenorrhea was also significantly reduced(P<0.05),with a preoperatively and postoperatively median of visual analogue scale score(VAS)is 3(3)and 0(1),which improved the quality of life of patients.57 cases(81.4%)appeared menstrual pattern changed,specific as follows:43cases(61.4%)with menstrual quantity decreases,9 cases(12.9%)with menstrual extension,16 cases(22.9%)with a spotting bleeding,13 cases(18.6%)with amenorrhea,6 cases(8.6%)with frequently/prolonged bleeding,namely in 90 days,more than 5times bleeding and/or spotting bleeding or for 14 consecutive days of bleeding and/orspotting bleeding,and in the same patient may be merged in two and two or more menstrual patterns change.5 cases(7.1%)presented pelvic and abdominal pain,1 case presented severe lumbago,and the rest presented mild pain.2 cases(2.9%)developed a tolerable headache that did not interfere with normal life.16 patients(24.3%)reported new asymptomatic ovarian cysts,14 of which were unilateral and 2 of which were bilateral.The mean cyst diameter was 36.12±12.03mm,10 patients(62.5%)had transient ovarian cysts,and the remaining 6 patients(37.50%)could not determine their duration because the patient did not follow up regularly。Nine patients(12.9%)reported breast pain,of which 1 patient was found to have breast hyperplasia by breast ultrasound,and the other patients did not have breast nodules or hyperplasia during follow-up of breast surgery.1 patient with a history of depression reported improved symptoms after mirena placement,and 3 patients(4.3%)reported a new anxiety-depression tendency.3 patients(4.3%)gained weight after using mirena.A total of 10 patients(14.3%)discontinued treatment midway,8 patients(11.4%)tookout mirena due to displacement or abscission.,and two patients(2.9%)had removal due to side effects.The median satisfaction score of mirena(interquartile interval)was 9(2)points,63 patients were satisfied(90%)and 7 patients were dissatisfied(10%).Patients with frequent/prolonged bleeding patterns after using mirena had lower satisfaction scores(P<0.05),the difference was statistically significant(P<0.05).The satisfaction scores of patients with different preoperative clinical manifestations were statistically significant(P<0.05),among which patients presenting with prolonged menstrual period had the highest median satisfaction score(10),followed by patients with increased menstrual volume(9).Conclusion 1.Mirena implantation after TCRP can effectively prevent recurrence of endometrial polyps,and endometrial thickness is significantly lower than that before operation。For patients with combined dysmenorrhea,it can effectively reduce the degree of dysmenorrhea and improve the quality of life.2.90% of the patients were satisfied with mirena,and 81.4% of the patients appeared menstrual pattern change.The frequent/prolonged bleeding will decrease satisfaction of mirena,so fully explain to the patient should be in place before,in order to reduce the patient’s concerns,which could further improve patient satisfaction.3.Patients with different preoperative clinical manifestations had different satisfaction scores for mirena.Among them,patients with prolonged menstrual period had the highest median satisfaction score,followed by patients with increased menstrual volume.4.1 patients with a history of depression felt their depressive symptoms improved after using mirena,and 3 patients reported new anxiety-depression after mirena was placed.In this study,16 cases of newly developed ovarian cysts after the placement of mirena were reported,among which 10 cases showed spontaneous regression.However,due to the small sample size,it is necessary to further observe the related side effects caused by mirena.