Use of the levonorgestrel-releasing intrauterine device for the symptomatic treatment of uterine myomas

Abstract

Objective: To assess the effect of the levonorgestrel-releasing intrauterine device (LNG-IUD) for the treatment of patients with uterine myomas with increased bleeding by measuring total uterine volume and by determining patient clinical improvement, uterine artery flow velocity, and hemoglobin levels. Study design: Ten patients with a complaint of increased uterine bleeding associated with the presence of uterine myomas were assessed in a prospective, open and non-controlled study before and 6 months after the insertion of an levonorgestrel intrauterine device (LNG-IUD). The patients were assessed for intensity of bleeding, uterine volume, Doppler velocimetry of the uterine arteries, hematocrit and hemoglobin. Results: Three patients dropped out the study, one for personal reasons and two other patients presented spontaneous expulsion of the device after 2 and 4 months of follow-up, respectively. Of the seven patients who continued the study, three started to present a bleeding pattern of oligomenorrhea type and the other four entered amenorrhea. All patients ( n=6) with anemia at the beginning of the study presented normalization of hematocrit and hemoglobin levels after 6 months of treatment ( p=0.0003 and p<0.0001, respectively). However, we observed no reduction in uterine volume ( p=0.11) or in flow velocity assessed by uterine artery pulsatility index (right uterine p=0.17; left uterine p=0.19) and resistance index (right uterine p=0.54; left uterine p=0.31) using Doppler velocimetry. Conclusion: The use of the LNG-IUD can be effective in controlling uterine bleeding secondary to myomatosis even in the absence of reduction of uterine volume.