OC13.01: Sonographic findings in adenomyosis after insertion of levonorgestrel intrauterine device

Abstract

The aim of this study (2006–2011) was to assess whether the sonographically detectable morphological alterations of the myometrium induced by adenomyosis changed after insertion of the LNG-IUD. 120 premenopausal symptomatic patients (menorrhagia, severe dysmenorrhea) with minimum five sonographic findings (globular shaped uterus, myometrial cysts (2–6 mm), inhomogeneous myometrium, indistinct borders to a myometrial mass, indistinct endometrial stripe, subendometrial linear striations, hyperechoic myometrial nodules, asymmetric thickening of the anterior or posterior uterine wall, minimal mass effect on the endometrium or serosa) of adenomyosis were enrolled into the study. Before and at 3, 6 and 12 months after insertion of the LNG-IUD all the patients underwent transvaginal sonography which evaluated uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, thickness of uterine wall and asymmetric myometrium, presence of myometrial hyperechoic striation. Color Doppler can be utilized in all cases to help distinguish between leiomyomas and adenomyosis. 23 patients become amenorrheic at 6 months and at 12 months—43 patients become amenorrheic. 50 patients had a significant reduction in menstrual bleeding at 12 months. 4 patients need to extract the LNG-IUD because of important bleeding. Dysmenorrhea was significantly alleviated in all 78 patients. We observed a significant decrease in uterine volume (170.3 ± 10.4 mL vs. 104.5 ± 8.2 mL) and reduction in asymmetric wall thickness (29.3 ± 1.9 mm vs. 17.2 ± 2.8 mm). However sonographic signs of adenomyosis such as myometrial cystic areas and hyperechoic striation did not disappear. The accuracy of transvaginal ultrasound in the detection of adenomyosis is highly operator dependent. After insertion of a LNG-IUD in patients with adenomyosis, uterine volume decreased, the myometrial wall shrank and symptoms were significantly alleviated. However sonographic signs of adenomyosis did not seem to disappear completely.