Different bleeding patterns with the use of levonorgestrel intrauterine system: are they associated with changes in uterine artery blood flow?

Carlo Bastianelli,Roberta Bruno Vecchio,Giuseppe Benagiano,Stefania Rapiti,Manuela Farris

doi:10.1155/2014/815127

Abstract

Objective. Evaluate if different bleeding patterns associated with the use of the levonorgestrel intrauterine system (LNG-IUS) are associated with different uterine and endometrial vascularization patterns, as evidenced by ultrasound power Doppler analysis. Methodology. A longitudinal study, with each subject acting as its own control was conducted between January 2010 and December 2012. Healthy volunteers with a history of heavy but cyclic and regular menstrual cycles were enrolled in the study. Ultrasonographic examination was performed before and after six months of LNG-IUS placement: uterine volume, endometrial thickness, and subendometrial and myometrial Doppler blood flow patterns have been evaluated. Results. A total of 32 women were enrolled out of 186 initially screened. At six months of follow-up, all subjects showed a reduction in menstrual blood loss; for analysis, they were retrospectively divided into 3 groups: normal cycling women (Group I), amenorrheic women (Group II), and women with prolonged bleedings (Group III). Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI) and resistance index (RI) in the spiral arteries were significantly lower in Group I and Group III compared to Group II. This difference persisted also when comparing—within subjects of Group III—mean PI and RI mean values before and after insertion. Conclusions. The LNG-IUS not only altered endometrial thickness, but—in women with prolonged bleedings—also significantly changed uterine artery blood flow. Further studies are needed to confirm these results and enable gynecologists to properly counsel women, improving initial continuation rates.

Highlights

The levonorgestrel-releasing intrauterine system (LNG-IUS) has proven its efficacy, both as a long-acting contraceptive [1,2,3,4] and for its noncontraceptive benefits [5,6,7], including high effectiveness in the treatment of heavy menstrual bleeding [8,9,10,11]
Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI) and resistance index (RI) in the spiral arteries were significantly lower in groups: normal cycling women (Group I) and Group III compared to Group II
Group I included women in whom a cyclical menstrual bleeding pattern was maintained throughout the observation period

Summary

Introduction

The levonorgestrel-releasing intrauterine system (LNG-IUS) has proven its efficacy, both as a long-acting contraceptive [1,2,3,4] and for its noncontraceptive benefits [5,6,7], including high effectiveness in the treatment of heavy menstrual bleeding [8,9,10,11]. Prolonged or irregular bleeding during the first months after placement has been reported by 22% and 67% of women, respectively, usually declining by the end of the first year [12]. To reduce discontinuations due to the so-called “bleeding nuisances” [13, 14], women wishing to use the LNG-IUS should be properly counseled concerning bleeding patterns to be expected [15]. An increase in subendometrial vascularization has been documented in women complaining of major side effects (dysmenorrhea and/or irregular bleeding) following insertion of copperreleasing intrauterine devices (Cu-IUDs) [17, 18]

Methods

Results

Conclusion