Clinical experiences of the levonorgestrel-releasing intrauterine system in patients with large symptomatic adenomyosis

Abstract

Objective: The objective of this study was to evaluate the clinical aspects of the levonorgestrel-releasing intrauterine system (LNG-IUS) in patients with large adenomyosis associated with dysmenorrhea and/or heavy menstrual bleeding (HMB). Materials and methods: Data were collected retrospectively from 48 patients with large adenomyosis (gestational age ≥ 12 weeks during pelvic examination) diagnosed via transvaginal ultrasonography between January 2008 and December 2009. Clinical outcomes, including symptomatic changes of dysmenorrhea and HMB, uterine volume change, complications, and the overall success rate were evaluated in each patient after treatment with the LNG-IUS. Results: The patients' mean age was 41.7 ± 6.1 years, and the median follow-up duration was 20 months (range, 3–50 months). Significant improvements (p < 0.01) in dysmenorrhea and HMB were observed. There was no significant change in the uterine volume. The most common side effects were prolonged vaginal spotting (n = 28, 58.3%) and LNG-IUS expulsion (n = 18, 37.5%). Five (10.4%) patients underwent premature LNG-IUS removal and eight (16.7%) patients underwent hysterectomy. The overall success rate of the LNG-IUS was 68.8%. Conclusion: The LNG-IUS is a suitable alternative treatment option for the management of dysmenorrhea and HMB prior to hysterectomy, for patients with large adenomyosis.

Keywords

• adenomyosis
• dysmenorrhea
• heavy menstrual bleeding
• levonorgestrel-releasing intrauterine system