Preliminary report on the use of a levonorgestrel intrauterine system for the treatment of intermenstrual bleeding due to previous cesarean delivery scar defect.

Abstract

To evaluate the efficacy of levonorgestrel intrauterine system (LNG-IUS) treatment in patients with previous cesarean delivery scar defect (PCDS)-related intermenstrual bleeding. A total of six premenopausal patients who experienced PCDS-related intermenstrual bleeding were enrolled for conservative therapy with LNG-IUS (levonorgestrel 20 μg/24 h) insertion. The durations of menstruation before and after LNG-IUS insertion at 1, 6 and 12 months were recorded. A total of three missed menstrual cycles was defined as amenorrhea. Any side effects and the device expulsion rate were also recorded. Patient follow-up was at an outpatient clinic. Any missing data were obtained by telephone. At the start of the study the median duration of intermenstrual bleeding was 6.5 days (range 3-22 days). After 6 months treatment, two of the six patients had developed amenorrhea and two patients experienced cessation of vaginal spotting. One patient reported expulsion of the device. All patients except the one with device expulsion responded to the conservative treatment after 1 year. The findings of the current study support LNG-IUS being effective for the treatment of PCDS-related intermenstrual bleeding. The authors recommend LNG-IUS as a treatment option for PCDS-related intermenstrual bleeding.