The Levonorgestrel Intrauterine System Is an Effective Treatment in Selected Obese Women with Abnormal Uterine Bleeding

Abstract

Objective To evaluate the use of the levonorgestrel intrauterine system (LNG-IUS) in obese premenopausal women with abnormal uterine bleeding (AUB). Design Prospective observational study (Canadian Task Force Classification II-2). Setting University-affiliated teaching hospital. Patients Fifty-six obese women with body mass index (BMI) >30 kg/m 2. Interventions From January 2002 through September 2009, 56 obese patients (BMI >30 kg/m 2) with abnormal uterine bleeding (AUB) were identified from the senior author’s clinical practice (G.A.V.). After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, the LNG-IUS was placed to treat their AUB. Measurements and Main Results The median and (range) for age, parity, and BMI were 42.5 years (20–64), 2 children (0–6), and 41.2 kg/m 2 (30–61), respectively. Many patients had additional comorbid conditions placing them at high risk for traditional medical or surgical therapies. The initial endometrial biopsy result was normal in 46 women (82.1%). Three women (5.4%) had inadequate sample, three (5.4%) had simple endometrial hyperplasia, two (3.6%) had complex endometrial hyperplasia without atypia, and two women (3.6%) had complex endometrial hyperplasia with atypia. After placement of the LNG-IUS, all women reported menstrual blood reduction at 3 and 6 months. The LNG-IUS was expelled in 2/56 patients (3.6%) and removed in 12 (21.4%), and a new device was inserted in 3/56 patients (5.4%). At median follow-up of 48 months (range 3–72), the satisfaction rate was 75%. Conclusion In properly selected obese women with AUB, the LNG-IUS is an effective therapy in approximately 75% of cases.