Levonorgestrel-releasing Intrauterine Device Insertion Research Articles

Effects of Levonorgestrel-Releasing Intrauterine Device Therapy on Ovarian Reserve in Menorrhagia.

Objective This study aimed to investigate the effects of levonorgestrel-releasing intrauterine device (LNG-IUD) treatment on ovarian reserve in women of reproductive agediagnosed with menorrhagia. Methods This was a prospective controlled trial involving 50 women with menorrhagia and a control group comprising age-matched 50 healthy women.Women who satisfied the LNG group criteria underwent an endometrial pipelle biopsy and LNG-IUD insertion. Ovarian reserve tests were performed prior to and six months after LNG-IUD insertion in the LNG group cases. Results Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Müllerian hormone (AMH), endometrial thickness (ET), total antral follicle count (AFC), and mean ovarian volume values before LNG-IUD insertion did not differ between the LNG and control groups. When the final measurements were compared, FSH, AMH, total AFC, and average ovarian volume increased (p=0.05, 0.046, 0.022, and 0.022, respectively), E2 and ET decreased (p=0.034 and 0.001, respectively) in the LNG group, while LH did not differ significantly between the groups (p=0.71). Conclusion We observed that LNG-IUD use effectively improves fertility capacity. In this study, LNG-IUD use in reproductive-age women diagnosed with menorrhagia decreased E2 levels, did not change LH levels, and increased FSH, AFC, and AMH levels.

Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery.

Endometriosis is a condition characterised by the presence of ectopic deposits of endometrial-like tissue outside the uterus, usually in the pelvis. The impact of laparoscopic treatment on overall pain is uncertain and a significant proportion of women will require further surgery. Therefore, adjuvant medical therapies following surgery, such as the levonorgestrel-releasing intrauterine device (LNG-IUD), have been considered to reduce recurrence of symptoms. OBJECTIVES: To determine the effectiveness and safety of post-operative LNG-IUD in women with symptomatic endometriosis. We searched the following databases from inception to January 2021: The Specialised Register of the Cochrane Gynaecology and Fertility Group, CENTRAL (which now includes records from two trial registries), MEDLINE, Embase, PsycINFO, LILACS and Epistemonikos. We handsearched citation lists of relevant publications, review articles, abstracts of scientific meetings and included studies. We contacted experts in the field for information about any additional studies. We included randomised controlled trials (RCTs) comparing women undergoing surgical treatment of endometriosis with uterine preservation who were assigned to LNG-IUD insertion, versus control conditions including expectant management, post-operative insertion of placebo (inert intrauterine device), or other medical treatment such as gonadotrophin-releasing hormone agonist (GnRH-a) drugs. Two review authors independently selected studies for inclusion, and extracted data to allow for an intention-to-treat analysis. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence interval (CI) using the Mantel-Haenszel fixed-effect method. For continuous data, we calculated the mean difference (MD) and 95% CI using the inverse variance fixed-effect method. Four RCTs were included, with a total of 157 women. Two studies areongoing. The GRADE certainty of evidence was very low to low. The certainty of evidence was graded down primarily for serious risk of bias and imprecision. LNG-IUD versus expectant management Overall pain: No studies reported on the primary outcome of overall pain. Dysmenorrhoea: We are uncertain whether LNG-IUD improves dysmenorrhoea at 12 months. Data on this outcome were reported on by two RCTs; meta-analysis was not possible (RCT 1: delta of median visual analogue scale (VAS) 81 versus 50, P = 0.006, n = 55; RCT 2: fall in VAS by 50 (35 to 65) versus 30 (25 to 40), P = 0.021, n = 40; low-certainty evidence). Quality of life: We are uncertain whether LNG-IUD improves quality of life at 12 months. One trial demonstrated a change in total quality of life score with postoperative LNG-IUD from baseline (mean 61.2 (standard deviation (SD) 14.8) to 12 months (mean 70.3 (SD 16.2) compared to expectant management (baseline 55.1 (SD 17.0) to 57.0 (SD 33.2) at 12 months) (n = 55, P = 0.014, very low-certainty evidence). Patient satisfaction: Two studies found higher rates of satisfaction with LNG-IUD compared to expectant management; however, combining the studies in meta-analysis was not possible (n = 95, very low-certainty evidence). One study found 75% (15/20) of those given post-operative LNG-IUD were "satisfied" or "very satisfied", compared to 50% (10/20) of those in the expectant management group (RR 1.5, 95% CI 0.90-2.49, 1 RCT, n=40, very low-certainty evidence). The second study found that fewer were "very satisfied" in the expectant management group when compared to LNG, but there were no data to include in a meta-analysis. Adverse events: One study found a significantly higher proportion of women reporting melasma (n = 55, P = 0.015, very low-certainty evidence) and bloating (n = 55, P = 0.021, very low-certainty evidence) following post-operative LNG-IUD. There were no differences in other reported adverse events, such as weight gain, acne, and headaches. LNG-IUD versus GnRH-a Overall pain: No studies reported on the primary outcome of overall pain. Chronic pelvic pain: We are uncertain whether LNG-IUD improves chronic pelvic pain at 12 months when compared to GnRH-a (VAS pain scale) (MD -2.0, 95% CI -20.2 to 16.2, 1 RCT, n = 40, very low-certainty evidence). Dysmenorrhoea: We are uncertain whether LNG-IUD improves dysmenorrhoea at six months when compared to GnRH-a (measured as a reduction in VAS pain score) (MD 1.70, 95%.CI -0.14 to 3.54, 1 RCT, n = 18, very low-certainty evidence). Adverse events: One study suggested that vasomotor symptoms were the most common adverse events reported with patients receiving GnRH-a, and irregular bleeding in those receiving LNG-IUD (n = 40, very low-certainty evidence) AUTHORS' CONCLUSIONS: Post-operative LNG-IUDiswidely used to reduce endometriosis-related pain and to improve operative outcomes. This review demonstrates thatthere is nohigh-qualityevidence to supportthis practice. This review highlights the need for further studies with large sample sizes to assess theeffectivenessof post-operative adjuvant hormonal IUD on the core endometriosis outcomes (overall pain,most troublesome symptom, and quality of life).

Evaluation of Gynecologist’s and Patient’s Experience, Anxiety and Pain Perception During Intrauterine Device Insertion Containing Levonorgestrel (ELA 52 Study)

Objective: To characterize patient’s and obstetricians-gynecologist’s (ob-gyns) experience in insertion of a 52 mg levonorgestrel‐ releasing intrauterine device (LNG-IUD). Materials and Methods: A non-interventional, prospective and multicentric study was conducted in 583 patient of reproductive age who had insertion of Levosert® following routine clinical practice. Questionnaires were used to collect information on obgyns’ and patient’s experiences associated with IUD insertion. Pain and anxiety were rated, and possible predictors such as age and parity were evaluated. Results: Before IUD insertion, 50.8% of the participants felt minimal anxiousness and 44.9% predicted moderate pain. Twohundred and sixteen (37.0%) patient reported mild pain with insertion and 227 (38.9%) reported moderate pain. Ob-gyns were aware of the patient’s insertion pain experience and 84.2% considered LNG-IUD insertion “Easy” or “Very Easy”. The vast majority of patient (88.2%) were also “Satisfied” or “Very Satisfied” with LNG-IUD insertion, considering the procedure less or at least equally painful as they expected. Conclusions: Given the strong link between anxiety and expected pain and the lack pain management strategies effectiveness, the implementation of interventions that may mitigate both anxiety and pain during IUD insertion are crucial. LNG-IUD is associated with high satisfaction rates by patient and considered easy to apply by ob-gyns.

P–302 Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery: a Cochrane systematic review

Abstract Study question Does levonorgestrel-releasing intrauterine device (LNG-IUD) improve post-operative outcomes for endometriosis when compared to other systemic hormonal treatments or no additional treatment? Summary answer We are uncertain whether LNG-IUD has an impact on dysmenorrhoea when compared to no postoperative treatment or post-operative GnRH agonists (GnRH-a). What is known already Endometriosis is a condition characterised by the presence of ectopic deposits of endometrial-like tissue outside the uterus, usually in the pelvis; inducing a chronic inflammatory response which can lead to pelvic pain and infertility. Various treatment options exist including surgical treatment, ovarian suppression therapy, or a combination of these strategies. The impact of laparoscopic treatment on overall pain is uncertain and a significant proportion of women will require further surgery. Therefore, adjuvant medical therapies such as LNG-IUD have been considered to reduce treatment failure and recurrence of symptoms. Study design, size, duration A Cochrane systematic review and meta-analysis was performed. Electronic searches of the Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL and Epistemonikos were conducted to January 2021 for relevant randomised controlled trials (RCTs). Two independent authors screened studies and extracted data. Risk ratios (RR) were calculated for dichotomous data and standardised mean differences (SMD) for continuous data, with 95% confidence intervals (CI). Heterogeneity was examined via the I² statistic. Participants/materials, setting, methods Participants: women undergoing surgical treatment for endometriosis without hysterectomy Intervention: LNG-IUD insertion within three months of surgery Comparison: No postoperative treatment, placebo IUD or any other systemic treatment Primary outcome: overall pain Secondary outcomes: improvement of the most troublesome symptom, dysmenorrhoea, quality of life, satisfaction with treatment and adverse events. Primary analysis was conducted on data per woman randomised. Main results and the role of chance Four RCTs were included, with a total of 157 women. Five studies are awaiting classification and one is an ongoing study. We corresponded with original study authors to clarify missing outcome data. No studies reported on overall pain or improvement in the most troublesome symptom. We await study author clarification on quality of life and treatment satisfaction data. We are uncertain whether LNG-IUD improves dysmenorrhoea compared to no postoperative treatment at 12 months. Data on this outcome were reported on by 2 RCTs, but were expressed as median and inter-quartile range and so meta-analysis was not possible (RCT 1: delta of median visual analog scale (VAS) 81 versus 50, p = 0.006, n = 55; RCT 2: fall in VAS by 50 (35–65) p = 0.012 versus 30 (25– 40), p = 0.021, n = 40). We are uncertain whether compared to post-operative GnRH-a, LNG-IUD affects rates of dysmenorrhoea at 6 months (VAS SMD 0.79, 95% CI –0.08 to 1.67, p = 0.08, one RCT, n = 22, very low quality evidence). Various adverse events with LNG-IUD were reported including irregular bleeding and weight gain. However, due to a lack of raw data and comparable studies, we were unable to undertake meta-analysis. Limitations, reasons for caution The major limitation of this systematic review was that there were insufficient studies reporting on our prespecified outcomes, including our primary outcome. In addition, the included studies were not all of high quality with limited long-term follow-up. Wider implications of the findings: This systematic review highlights the paucity of RCTs reporting outcomes included in the new core outcome set for endometriosis research. Further high-quality RCTs are needed to assess postoperative adjuvant hormonal therapy and these should prioritise investigating key endometriosis outcomes such as overall pain, quality of life and treatment satisfaction. Trial registration number Not applicable

Predictive Accuracy of Progesterone Receptor B in Young Women with Atypical Endometrial Hyperplasia and Early Endometrial Cancer Treated with Hysteroscopic Resection plus LNG-IUD Insertion

The immunohistochemical expression of isoform B of the progesterone receptor (PRB) has shown promising results in predicting the response of atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC) to conservative treatment. We aimed to calculate the accuracy of PRB as a predictive marker of conservative treatment outcome in AEH or EEC. Retrospective cohort study. University of Naples Federico II, Naples, Italy. Thirty-six consecutive premenopausal women <45 years of age with AEH (n = 29) or EEC (n = 7) conservatively treated from January 2007 to June 2018 were retrospectively assessed. All patients had been treated with hysteroscopic resection plus levonorgestrel-releasing intrauterine device insertion and followed for at least 1 year. The immunohistochemical expression of PRB was separately assessed in the glands and stroma of the lesion and dichotomized as "weak" or "normal." The treatment outcomes considered were (1) treatment failure (i.e., a combined outcome including no regression or recurrence); (2) no regression; and (3) recurrence. The predictive accuracy of PRB immunohistochemistry was assessed by calculating sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC). A weak glandular PRB expression showed SE = 70%, SP = 77%, and AUC = 0.74 for treatment failure; SE = 66.7%, SP = 70%, and AUC = 0.68 for no regression; and SE = 75%, SP = 68.8%, and AUC = 0.72 for recurrence. A weak stromal PRB expression showed SE = 100%, SP = 53.8%, and AUC = 0.77 for treatment failure; SE = 100%, SP = 46.7%, and AUC = 0.73 for no regression; and SE = 100%, SP = 43.8%, and AUC = 0.72 for recurrence. A weak stromal PRB expression is a highly sensitive predictive marker of both no response and recurrence of AEH and EEC conservatively treated.

Pain Perception during Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Women: A Systematic Review.

Intrauterine devices (IUDs) still remain underused in adolescents. Pain during insertion might prevent adolescents to opt for a levonorgestrel-releasing IUD. This study aimed to conduct a systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and critically appraise published data with respect to the efficacy of various substances (analgesics or not) in preventing pain during levonorgestrel-releasing IUD insertion in nulliparous women as a proxy for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A comprehensive computerized systematic literature search of all English language studies between 2006 and 2016 was performed in PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were manually searched. The computerized database search revealed 31 citations of relevance, 9 of which with a total of 355 treated women and 345 controls fulfilled the inclusion/exclusion criteria. In women treated with misoprostol (n=150) vs placebo (n=145), the median visual analogue scale (VAS) score±SD were 5.7±2.1 vs 5.1±2.2, respectively. In the previously mentioned population, there was a nonsignificant change in VAS score (odds ratio, 1.44; 95% confidence interval, 0.86-2.40). In women treated with lidocaine (n=140) vs placebo (n=136), the median VAS score±SD were 4.6±2.1 vs 5.8±2, respectively. In the aforementioned population, there was a significant decrease in VAS score (odds ratio, 0.12; 95% confidence interval, 0.02-0.91). In nulliparous women, lidocaine treatment seems to be a reasonable choice. However, further studies are required to examine the different routes and modes of administration as well as optimal quantities.

Relationship between uterine volume and discontinuation of treatment with levonorgestrel-releasing intrauterine devices in patients with adenomyosis.

This study is to evaluate the relationship between the uterine volume and the failure of levonorgestrel-releasing intrauterine device (LNG-IUD) in patients with adenomyosis. A total of 171 women with adenomysis were treated with LNG-IUD from November 2009 to December 2011. The amount of menorrhagia, degree of dysmenorrhea, and the uterine volume were compared before and after insertion of LNG-IUD, and the treatment failure of LNG-IUD was observed. The mean age of the participants was 42.5years (range 29-53years). The mean uterine volume was 158mL (range 46-769mL). Among the total participants, 37 (21.6%) discontinued the treatment prematurely. There were no different characteristics between the ongoing treatment group and treatment failure group with LNG-IUD. However, there was significant difference of uterine volume between two groups (178±14 and 141±7mL, P=0.010). Based on the receiver operator characteristic analysis, the optimum cutoff value of uterine volume more than 150mL was significantly associated with failure of LNG-IUD (area under curve: 0.763, 95% CI 0.669-0.856). In univariate analysis, the uterine volume more than 150mL was the only independent factor for the failure of LNG-IUD (odds ratio 6.76, 95% CI 1.20-38.02, P=0.030). The rate of treatment failure after LNG-IUD insertion for the patients with adenomyosis was related to the uterine volume. Specifically, the treatment failure rate of large volume uterus (>150mL) with LNG-IUD was significantly higher than that of small volume uterus.

Effect of the Levonorgestrel Intrauterine Device on Genital HIV-1 RNA Shedding Among HIV-1–Infected Women Not Taking Antiretroviral Therapy in Nairobi, Kenya

The effect of the levonorgestrel-releasing intrauterine device (LNG-IUD) on genital HIV-1 RNA shedding and inflammation among 25 HIV-infected women was evaluated. Blood, endocervical, and cervicovaginal lavage samples were collected from HIV-infected women not taking antiretrovirals before LNG-IUD insertion and 1 month, 3 month, and 6 months thereafter. HIV-1 RNA was quantitated by real-time reverse transcriptase-polymerase chain reaction. Inflammatory markers were measured by enzyme immunoassay. Genital HIV-1 RNA shedding and inflammatory markers did not differ between LNG-IUD placement and month 6, with the exception of interleukin 1β that increased (0.42 log10; 95% confidence interval: 0.10 to 0.75). The LNG-IUD did not increase genital HIV-1 RNA shedding after 6 months of use.

Levonorgestrel-releasing intrauterine device for symptomatic endometriosis following surgery

Objectives The aim of this study was to determine whether postoperative levonorgestrel-releasing intrauterine device (LNG-IUD) insertion in women with endometriosis improves pain and reduces symptoms compared with no treatment, placebo, or systemic therapy. Data source The following databases were searched from inception to June 2012: Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, CINAHL, and the World Health Organization International Clinical Trials Registry Platform. EMBASE was searched from 2010 to June 2012. The citation lists of relevant publications, review articles, abstracts of scientific meetings, and included studies were also searched. Study selection Randomized trials comparing women who underwent LNG-IUD insertion with those who received no treatment, a placebo, or systemic therapy after surgical treatment for endometriosis within the preceding 3 months were included. Data extraction Two review authors independently selected studies for inclusion and extracted data to allow for an intention-to-treat analysis. For dichotomous data, the risk ratio (RR) and 95% confidence interval (CI) were calculated using the Mantel–Haenszel random-effects method. For continuous data, the mean difference (MD) and 95% CI were calculated using the inverse variance random-effects method. Results A total of three randomized-controlled trials were included. In two trials, there was a statistically significant reduction in the recurrence of painful menstruation in the LNG-IUD group compared with expectant management (RR 0.22, 95% CI 0.08–0.60, 95 women, I2 0%, moderate strength of evidence). The proportion of women who were satisfied with their treatment was also higher in the LNG-IUD group but did not reach statistical significance (RR 1.21, 95% CI 0.80–1.82, 95 women, I2 0%). The number of women reporting a change in their menstruation was significantly higher in the LNG-IUD group (RR 37.80, 95% CI 5.40–264.60, 95 women, I2 0%); however, the number of women who failed to complete the allocated treatment did not differ between the groups (RR 0.66, 95% CI 0.08–5.25, I2 43%). In one trial, women receiving LNG-IUD achieved slightly lower pain scores compared with women receiving gonadotropin-releasing hormone (GnRH) agonists (MD −0.16, 95% CI −2.02 to 1.70, 40 women), but this did not reach statistical significance. Conclusion There is limited but consistent evidence showing that postoperative LNG-IUD use reduces the recurrence of painful menstruation in women with endometriosis. Further well-designed randomized-controlled trials are needed to confirm these findings.

Levonorgestrel-releasing Intrauterine Device is an Efficacious Contraceptive for Women with Leiomyoma

To evaluate the efficacy of a levonorgestrel-releasing intrauterine device (LNG-IUD) as contraception for women with uterine leiomyoma. Thirty women with uterine leiomyoma requiring contraception were enrolled and had a LNG-IUD inserted. Menstrual blood volume (assessed by a pictorial blood loss assessment chart [PBAC]), haemoglobin concentration, volume of uterus and leiomyoma were determined before and after LNG-IUD insertion. The median (range) PBAC score was 145.0 (60.0-232.0) before LNG-IUD insertion, which significantly decreased to 44.0 (0.0-99.0) and 36.0 (0.0-90.0) after 6 and 12 months of LNG-IUD use, respectively. Prior to LNG-IUD insertion, the median haemoglobin concentration in patients with anaemia was 100.0 (69.0-109.0) g/l and this increased significantly after 6 and 12 months of LNG-IUD use, to 117.5 (101.0-131.0) g/l and 119.5 (108.0-135.0) g/l, respectively. There were no significant changes in uterine or leiomyoma volumes. No patient became pregnant and there were no severe side-effects; one IUD was expulsed. The LNG-IUD may be a safe and effective contraceptive for women of reproductive age with uterine leiomyoma.

Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation: a randomized controlled trial

BackgroundThe study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study DesignWe enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. ResultsOf the 93 subjects enrolled, 88 were randomized. All 44 subjects (100%) randomized to immediate insertion had successful IUD placement, while only 20 (45.5%) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5%, 95% confidence interval (CI) 39.8%–69.3%]. Seventeen (38.6%) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2%) and 17 of 27 women (62.9%) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2%, 95% CI −0.4% to 44.8%). Intrauterine device expulsion occurred in three subjects (6.8%) and one subject (5.0%) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. ConclusionSignificantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.

Vaginal danazol for women with rectovaginal endometriosis and pain symptoms persisting after insertion of a levonorgestrel-releasing intrauterine device

Objective To evaluate the effectiveness of treatment with vaginal danazol in improving the pain symptoms caused by rectovaginal endometriosis that persist after insertion of a levonorgestrel-releasing intrauterine device (LNG-IUD). Methods This pilot observational study included 15 women with rectovaginal endometriosis and pain symptoms persisting after LNG-IUD insertion. Vaginal danazol (100 mg per day) was self-administered for 6 months. The intensity of pain symptoms and the volume of rectovaginal endometriotic nodules were evaluated. Results Twelve women were satisfied or very satisfied with the treatment. After treatment with vaginal danazol for 3 months, there was a significant decrease in the intensity of pain symptoms compared with their intensity before the administration of danazol. The intensity of pain symptoms decreased further at 6-month follow-up. The volume of the rectovaginal nodules decreased after treatment with vaginal danazol for 6 months (1.7 ± 0.8 cm 3) compared with the baseline volume (2.3 ± 0.9 cm 3; P < 0.001). Adverse effects of the treatment were minimal and well tolerated. Conclusion Although a placebo effect cannot be excluded, the results indicate that vaginal danazol decreases the severity of endometriosis-related pain symptoms after LNG-IUD insertion.

Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis

The aim of this study was to evaluate the long-term clinical effects of a levonorgestrel-releasing intrauterine device (LNG-IUD) on adenomyosis. A LNG-IUD was inserted into 47 patients who were diagnosed with adenomyosis. Uterine volume, uterine artery blood flow, pictorial blood loss assessment chart (PBAC) scores, and the degree of dysmenorrhea were evaluated before and 36 months after insertion of the LNG-IUD. Pain scores and PBAC scores dropped dramatically in 6 months and showed significant decrease after 36 months. A significant decrease in mean uterine volume was noted 12 months (156.85 +/- 49.79 mL to 118.64 +/- 41.36 mL; P < .001) and 24 months (128.84 +/- 48.70 mL; P < .001) after LNG-IUD insertion, but no significant differences were noted at 36 months. The mean pulsatility indices of both uterine arteries increased significantly 12 months after insertion (P = .002 for right; P = .011 for left) and decreased after 24 months without significance. Uterine volume and uterine blood flow were negatively correlated (Pearson's correlation, P < .05). Significant increase of uterine volume, pain scores, and PBAC scores were noted at 36 months compared with 12 months after insertion (P = .034, .021, and .001, respectively). For patients with clinical diagnosis of adenomyosis, the LNG-IUD is effective for the reduction of uterine volume with improvement of vascularity and relief of symptoms. However, the efficacy of LNG-IUD on uterine volume may begin to decrease 2 years after insertion.

The Efficacy of Levonorgestrel-Releasing Intrauterine Device in Selected Cases of Myoma-Related Menorrhagia: A Prospective Controlled Trial

Background/Aims: To determine the efficacy of levonorgestrel-releasing intrauterine device (LNG-IUD) insertion in menorrhagic patients who have at least one type II myoma according to the European Society of Hysteroscopy. The primary outcome measures were menstrual blood flow reduction and increase in hemoglobin values. The secondary outcome measures were hysterectomy rates and patient satisfaction. Methods: In menorrhagic women (documented by a validated pad scoring system) with a myomatous uterus <380 ml at ultrasonography, LNG-IUD was inserted after the diagnostic triage. Patients were evaluated at 3, 6 and 12 months after the insertion. The primary outcome measures were compared to those of a matched group of historical controls that underwent thermal balloon ablation (TBA). Results: Following LNG-IUD insertion, statistically significant decreases in menstrual blood flow and increases in hemoglobin values were noted. LNG-IUD insertion was found to be as effective as historical controls of TBA applications. Conclusion: This prospective controlled trial demonstrates the effectiveness of LNG-IUD in this setting and equivalent results are obtained as compared to TBA.

Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study

Objective To determine whether the frequency and severity of dysmenorrhea are reduced in women with symptomatic endometriosis in whom a levonorgestrel-releasing intrauterine device (Lng-IUD) is inserted after operative laparoscopy compared with those treated with surgery only. Design Open-label, parallel-group, randomized, controlled trial. Setting A tertiary care and referral center for patients with endometriosis. Patient(s) Parous women with moderate or severe dysmenorrhea undergoing first-line operative laparoscopy for symptomatic endometriosis. Intervention(s) Randomization to immediate Lng-IUD insertion or expectant management after laparoscopic treatment of endometriotic lesions. Main outcome measure(s) Proportions of women with recurrence of moderate or severe dysmenorrhea in the two study groups 1 year after surgery and overall degree of satisfaction with treatment. Result(s) Moderate or severe dysmenorrhea recurred in 2 of 20 (10%) subjects in the postoperative Lng-IUD group and 9/20 (45%) in the surgery-only group. Thus, a medicated device inserted postoperatively will prevent the recurrence of moderate or severe dysmenorrhea in one out of three patients 1 year after surgery. A total of 15/20 (75%) women in the Lng-IUD group and 10/20 (50%) in the expectant management group were satisfied or very satisfied with the treatment received. Conclusion(s) Insertion of an Lng-IUD after laparoscopic surgery for symptomatic endometriosis significantly reduced the medium-term risk of recurrence of moderate or severe dysmenorrhea.

Levonorgestrel-releasing intrauterine device (Lng-IUD) versus expectant management after conservative surgery for symptomatic endometriosis. A pilot study

Objective: To verify if the frequency and severity of dysmenorrhea is reduced and time to symptom recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery plus Lng-IUD insertion compared with women treated with surgery only. Dyspareunia and nonmenstrual pain were also evaluated.