Endometrial resection following levonorgestrel intrauterine system treatment for menorrhagia

Abstract

The objective of this study was to evaluate long-term outcomes and hysterectomy rates after hysteroscopic endometrial resection among women following use of a levonorgestrel-releasing intrauterine system (LNG-IUS) for menorrhagia and among women never using this. Forty-five women who had used LNG-IUS for treatment of menorrhagia underwent endometrial resection. Each of them was matched with a patient who had never used LNG-IUS and who had been treated by endometrial resection for menorrhagia (control group). These two groups were compared for operative outcomes, additional procedures, outcome of menstrual bleeding, and for subsequent hysterectomy, which was the endpoint of this study. During the mean follow-up period of 5.8 years, 19 (44%) women undergoing endometrial resection following LNG-IUS and 14 (31%) with endometrial resection and without use of LNG-IUS underwent at least one gynecological procedure. Hysterectomy was performed in 14 (33%) women who had used LNG-IUS and in seven (16%) in the control group (p = 0.05). The main indications for hysterectomy were pain and enlarged uterus; leiomyomas and/or adenomyosis were found in specimens of the uterus extirpated, except for two cases with hematometra in both groups. Patients not hysterectomized reported amenorrhea or slight bleeding, and this response persisted for years after the treatment. In conclusion, two of three women avoided hysterectomy when endometrial resection followed LNG-IUS although hysterectomy rate was higher than those who had never used the device. Hysteroscopic surgery may be considered as an alternative to hysterectomy after discontinuation of LNG-IUS for menorrhagia.