Skip to main content
Erschienen in: The Journal of Obstetrics and Gynecology of India 1/2016

30.03.2016 | Original Article

The Effectiveness of Levonorgestrel-Releasing Intrauterine System in the Treatment of Heavy Menstrual Bleeding

verfasst von: Georgy Joy Eralil

Erschienen in: The Journal of Obstetrics and Gynecology of India | Sonderheft 1/2016

Einloggen, um Zugang zu erhalten

Abstract

Objective

Levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to be an effective treatment for patients with abnormal uterine bleeding (AUB) in many Western studies. The purpose of study was to examine the effectiveness of LNG-IUS in the treatment of Indian women with AUB.

Methods

We conducted a retrospective observational study of 70 women diagnosed with AUB and treated with LNG-IUS insertion between February 2010 and 2014 at the Department of Gynecology of Sree Narayana Institute of Medical Sciences. Baseline endometrial biopsies were done before insertion of LNG-IUS, and outpatient follow-up with symptom diary was undertaken at 3-month intervals after insertion of LNG-IUS.

Results

Primary outcome in the two treatment groups was significantly greater among women assigned to levonorgestrel-IUS than among those assigned to usual treatment (mean difference in scores over the course of 1 year 13.4 points; 95 % confidence interval [CI] 9.9–16.9; P < 0.001). All six domains of the MMAS favored the levonorgestrel-IUS at every time point (P < 0.001) with the use of a test for trend.

Conclusion

In conclusion, our study showed that both the levonorgestrel-IUS and usual medical treatments reduced the adverse effect of menorrhagia on women’s lives over the course of 2 years, but the levonorgestrel-IUS was the more effective first choice, as assessed by the impact of bleeding on the women’s quality of life.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Higham JM, Shaw RW. Clinical associations with objective menstrual blood volume. Eur J Obstet Gynecol Reprod Biol. 1999;82:73–6.CrossRefPubMed Higham JM, Shaw RW. Clinical associations with objective menstrual blood volume. Eur J Obstet Gynecol Reprod Biol. 1999;82:73–6.CrossRefPubMed
2.
Zurück zum Zitat Warner P, Critchley HO, Lumsden MA, et al. Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management. BMJ. 2001;323:24–8.CrossRefPubMedPubMedCentral Warner P, Critchley HO, Lumsden MA, et al. Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management. BMJ. 2001;323:24–8.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat National Collaborating Centre for Women’s and Children’s Health. Heavy menstrual bleeding. London: Royal College of Obstetricians and Gynaecologists; 2007 (guideline CG44). National Collaborating Centre for Women’s and Children’s Health. Heavy menstrual bleeding. London: Royal College of Obstetricians and Gynaecologists; 2007 (guideline CG44).
4.
Zurück zum Zitat Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97:734–9.CrossRefPubMed Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97:734–9.CrossRefPubMed
5.
Zurück zum Zitat Santer M, Wyke S, Warner P. What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study. BMC Womens Health. 2007;7:8.CrossRefPubMedPubMedCentral Santer M, Wyke S, Warner P. What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study. BMC Womens Health. 2007;7:8.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Endrikat J, Vilos G, Muysers C, et al. The levonorgestrel-releasing intrauterine system provides a reliable, long-term treatment option for women with idiopathic menorrhagia. Arch Gynecol Obstet. 2012;285:117–21.CrossRefPubMed Endrikat J, Vilos G, Muysers C, et al. The levonorgestrel-releasing intrauterine system provides a reliable, long-term treatment option for women with idiopathic menorrhagia. Arch Gynecol Obstet. 2012;285:117–21.CrossRefPubMed
7.
Zurück zum Zitat Stewart A, Cummins C, Gold L, et al. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG. 2001;108:74–86.PubMed Stewart A, Cummins C, Gold L, et al. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG. 2001;108:74–86.PubMed
8.
Zurück zum Zitat Middleton LJ, Champaneria R, Daniels JP, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010;341:c3929.CrossRefPubMedPubMedCentral Middleton LJ, Champaneria R, Daniels JP, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010;341:c3929.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Frick KD, Clark MA, Steinwachs DM, et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Womens Health Issues. 2009;19:70–8.CrossRefPubMed Frick KD, Clark MA, Steinwachs DM, et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Womens Health Issues. 2009;19:70–8.CrossRefPubMed
10.
Zurück zum Zitat Shaw RW, Brickley MR, Evans L, et al. Perceptions of women on the impact of menorrhagia on their health using multi-attribute utility assessment. Br J Obstet Gynaecol. 1998;105:1155–9.CrossRefPubMed Shaw RW, Brickley MR, Evans L, et al. Perceptions of women on the impact of menorrhagia on their health using multi-attribute utility assessment. Br J Obstet Gynaecol. 1998;105:1155–9.CrossRefPubMed
11.
Zurück zum Zitat Pattison H, Daniels JP, Kai J, et al. The measurement properties of the menorrhagia multi-attribute quality-of-life scale: a psychometric analysis. BJOG. 2011;118:1528–31.CrossRefPubMed Pattison H, Daniels JP, Kai J, et al. The measurement properties of the menorrhagia multi-attribute quality-of-life scale: a psychometric analysis. BJOG. 2011;118:1528–31.CrossRefPubMed
12.
Zurück zum Zitat Matteson KA, Boardman LA, Munro MG, et al. Abnormal uterine bleeding: a review of patient-based outcome measures. Fertil Steril. 2009;92:205–16.CrossRefPubMed Matteson KA, Boardman LA, Munro MG, et al. Abnormal uterine bleeding: a review of patient-based outcome measures. Fertil Steril. 2009;92:205–16.CrossRefPubMed
13.
Zurück zum Zitat Habiba M, Julian S, Taub N, et al. Limited role of multi-attribute utility scale and SF-36 in predicting management outcome of heavy menstrual bleeding. Eur J Obstet Gynecol Reprod Biol. 2010;148:81–5.CrossRefPubMed Habiba M, Julian S, Taub N, et al. Limited role of multi-attribute utility scale and SF-36 in predicting management outcome of heavy menstrual bleeding. Eur J Obstet Gynecol Reprod Biol. 2010;148:81–5.CrossRefPubMed
14.
Zurück zum Zitat Protheroe J, Bower P, Chew-Graham C, et al. Effectiveness of a computerized decision aid in primary care on decision making and quality of life in menorrhagia: results of the MENTIP randomized controlled trial. Med Decis Mak. 2007;27:575–84.CrossRef Protheroe J, Bower P, Chew-Graham C, et al. Effectiveness of a computerized decision aid in primary care on decision making and quality of life in menorrhagia: results of the MENTIP randomized controlled trial. Med Decis Mak. 2007;27:575–84.CrossRef
15.
Zurück zum Zitat Thirlaway K, Fallowfield L, Cuzick J. The Sexual Activity Questionnaire: a measure of women’s sexual functioning. Qual Life Res. 1996;5:81–90 (Erratum, Qual Life Res 1997;6:606).CrossRefPubMed Thirlaway K, Fallowfield L, Cuzick J. The Sexual Activity Questionnaire: a measure of women’s sexual functioning. Qual Life Res. 1996;5:81–90 (Erratum, Qual Life Res 1997;6:606).CrossRefPubMed
16.
Zurück zum Zitat Sitruk-Ware R, Inki P. The levonorgestrel intrauterine system: long-term contraception and therapeutic effects. Womens Health (Lond Engl). 2005;1:171–82.CrossRef Sitruk-Ware R, Inki P. The levonorgestrel intrauterine system: long-term contraception and therapeutic effects. Womens Health (Lond Engl). 2005;1:171–82.CrossRef
17.
Zurück zum Zitat Kriplani A, Singh BM, Lal S, et al. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet. 2007;97:190–4.CrossRefPubMed Kriplani A, Singh BM, Lal S, et al. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet. 2007;97:190–4.CrossRefPubMed
18.
Zurück zum Zitat Habiba M, Julian S, Taub N, et al. Limited role of multi-attribute utility scale and SF-36 in predicting management outcome of heavy menstrual bleeding. Eur J Obstet Gynecol Reprod Biol. 2010;148:81–5.CrossRefPubMed Habiba M, Julian S, Taub N, et al. Limited role of multi-attribute utility scale and SF-36 in predicting management outcome of heavy menstrual bleeding. Eur J Obstet Gynecol Reprod Biol. 2010;148:81–5.CrossRefPubMed
19.
Zurück zum Zitat Shapley M, Blagojevic M, Jordan K, et al. The spontaneous resolution of heavy menstrual bleeding in the perimenopausal years. BJOG. 2012;119:545–53.CrossRefPubMedPubMedCentral Shapley M, Blagojevic M, Jordan K, et al. The spontaneous resolution of heavy menstrual bleeding in the perimenopausal years. BJOG. 2012;119:545–53.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Shaw RW, Symonds IM, Tamizian O, et al. Randomised comparative trial of thermal balloon ablation and levonorgestrel intrauterine system in patients with idiopathic menorrhagia. Aust N Z J Obstet Gynaecol. 2007;47:335–40.CrossRefPubMed Shaw RW, Symonds IM, Tamizian O, et al. Randomised comparative trial of thermal balloon ablation and levonorgestrel intrauterine system in patients with idiopathic menorrhagia. Aust N Z J Obstet Gynaecol. 2007;47:335–40.CrossRefPubMed
21.
Zurück zum Zitat Ewies AA. Levonorgestrel-releasing intrauterine system—the discontinuing story. Gynecol Endocrinol. 2009;25:668–73.CrossRefPubMed Ewies AA. Levonorgestrel-releasing intrauterine system—the discontinuing story. Gynecol Endocrinol. 2009;25:668–73.CrossRefPubMed
22.
Zurück zum Zitat Hurskainen R, Teperi J, Rissanen P, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357:273–27724.CrossRefPubMed Hurskainen R, Teperi J, Rissanen P, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357:273–27724.CrossRefPubMed
Metadaten
Titel
The Effectiveness of Levonorgestrel-Releasing Intrauterine System in the Treatment of Heavy Menstrual Bleeding
verfasst von
Georgy Joy Eralil
Publikationsdatum
30.03.2016
Verlag
Springer India
Erschienen in
The Journal of Obstetrics and Gynecology of India / Ausgabe Sonderheft 1/2016
Print ISSN: 0971-9202
Elektronische ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-016-0865-3

Weitere Artikel der Sonderheft 1/2016

The Journal of Obstetrics and Gynecology of India 1/2016 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.