Clinical Efficacy of Levonorgestrel Releasing Intrauterine System versus Dienogest for Women having Symptomatic Adenomyosis

Abstract

Introduction: Adenomyosis is a common, estrogen-dependent, a benign gynaecological disease characterized by endometrial glands and stroma invading, implanting, and proliferating within the myometrium to form diffuse or localized lesions. Adenomyosis is common in women of childbearing age. The signs and symptoms include dysmenorrhea, menorrhagia, abnormal uterine bleeding, enlarged uterus, dyspareunia, and infertility, which can seriously affect the patient’s quality of life. The prevalence of adenomyosis varies widely from 5% to 70%, depending on the method used for diagnosis and the rate of diagnosis during hysterectomy is approximately 20– 30%. Aim of the Study: The aim of this study was to evaluate and compare the effectiveness between LNG-IUS and Dienogest among the woman with symptomatic adenomyosis. Methods: This was a randomized controlled trial and was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh during the period from July, 2021 to June, 2022. We included 20 patients with symptomatic adenomyosis diagnosis confirmed by transvaginal ultrasound in this study. All patients were divided by sequentially numbered sealed opaque envelops into two groups- Group A (who received LNG-IUS) & Group B ( who received dienogest). Among of 20 patients, 10 were in each group. Group A patients received LNG-IUS and group B patients received tablet dienogest(2mg) daily. VAS (visual analog scale) score, amount of uterine bleeding was assessed and uterine volume was measured by transvaginal ultrasound 3 months later. Result: In total 20 patients from both the groups completed the study. In our study we found majority of our patients (75%) were aged between 25 to 34 years old and 25 % were aged between 35 to 45 years old. We found the Mean ± SD of age was 34.80 ± 3.79 & 28.60 ± 3.17 respectively in group A & B. In group A and group B the mean of VAS at baseline & 3rd month was 9.10 ± 0.84 & 1.10 ± 1.10 and 8.75 ± 1.14 & 4.30 ± 2.41 respectively. At baseline the uterine volume was 268.08 ± 118.28 & 202.32 ± 117.76 and at 3rd month was 210.10 ±105.49 & 202.77 ± 118.33 among group A & B respectively the mean of hemoglobin level was 10.87 ±1.42 &10.82±0.64 at base line and 11.57 ±1.33 & 11.09± 0.53 after 3rd months in group A and group B respectively. Before treatment heavy menstruation was found 80% & 80% in group A & B respectively. After 3rd month correction of heavy menstruation was found 100% in group A. Among them amenorrhea was found 20% and regular menstruation was found 80%. Correction of heavy menstruation was found 50% in group B. Among them amenorrhea was found 20% and regular menstruation was found 30 %. Conclusion: In our study, we tried to evaluate the effects of LNG-IUS and dienogest on patients with symptomatic adenomyosis. We found that LNG-IUS is a useful tool for HMB and dysmenorrhea in women of all ages. In this study the LNG-IUS is proved to be an effective approach compared to dienogest to treat adenomyosis. Its use effectively reduced the severity of symptoms including heavy menstrual bleeding and dysmenorrhoea, uterine volume and improved laboratory outcomes.