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      Efficacy of Combined Levonorgestrel-Releasing Intrauterine System with Gonadotropin-Releasing Hormone Analog for the Treatment of Adenomyosis

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          Abstract

          Objectives

          To evaluate the clinical outcomes of gonadotropin-releasing hormone analog (GnRHa) combined with implantation of a levonorgestrel-releasing intrauterine system (LNG-IUS) in adenomyosis patients with significantly enlarged uteruses.

          Subjects and Methods

          Twenty-one adenomyosis patients whose uterine volumes were greater in size than at 12 weeks’ gestation were recruited for the study. Subcutaneous injection of GnRHa was administrated at an interval of 28 days for a total of 3-4 cycles when uterine length was determined to be less than 10 cm by ultrasound measurement. At 3, 6 and 12 months after LNG-IUS implantation, follow-up was performed to document the clinical values such as uterine volume, degree of dysmenorrhea and menstrual flow.

          Results

          Twelve months after implantation, the menstrual flow was significantly lower than baseline values (53.8 ± 11.7 vs. 100, p = 0.03). The degree of dysmenorrhea (pain) was relieved 12 months after implantation (58.2 ± 11.5 vs. 93.7 ± 0.2, p = 0.005). Uterine volume was also below pre-GnRHa levels after implantation (276.6 ± 32.1 vs. 311.4 ± 32.3, p = 0.005). LNG-IUS was expelled in 3 patients, giving an expulsion rate of 14%. Side effects of GnRHa combined with LNG-IUS implantation were few.

          Conclusion

          The findings indicate that combined GnRHa and LNG-IUS treatment was efficacious in patients with enlarged adenomyosis.

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          An update on adenomyosis.

          Michael Levy, A Dehaene, Estelle M N Laurent … (2013)
          Adenomyosis is a common benign uterine pathology that is defined by the presence of islands of ectopic endometrial tissue within the myometrium. It is asymptomatic in one third of cases, but when there are clinical signs they remain non-specific. It can often be misdiagnosed on sonography as it may be taken to be multiple uterine leiomyomata or endometrial thickening, both of which have a different prognosis and treatment. Adenomyosis is often associated with hormone-dependent pelvic lesions (myoma, endometriosis, or endometrial hyperplasia). It is less commonly connected to infertility or obstetrical complications and indeed any direct relationship remains controversial. The purpose of imaging is to make the diagnosis, to determine the extent of spread (focal or diffuse, superficial or deep adenomyosis, adenomyoma), and to check whether there is any associated disease, in particular endometriosis. The aim of this article is to provide assistance in recognising adenomyosis on imaging and to identify the pathologies that are commonly associated with it in order to guide the therapeutic management of symptomatic patients. Pelvic ultrasonography is the first line investigation. Sonohysterography can assist with diagnosis in some cases (pseudothickening of the endometrium seen on sonography). MRI may be used in addition to sonography to back up the diagnosis and to look for any associated disease.
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            Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device.

            Luigi Fedele, Stefano Bianchi, Ricciarda Raffaelli … (1997)
            To evaluate the efficacy and tolerability of treatment with a levonorgestrel-releasing intrauterine device (IUD) in women affected by adenomyosis-associated menorrhagia. Tertiary care center. Prospective, open, noncomparative study. Twenty-five women aged 38 to 45 years with recurrent menorrhagia associated with adenomyosis diagnosed at transvaginal ultrasonography participated in this study. An IUD releasing levonorgestel 20 mcg/day was inserted in each patient within 7 days of the start of menstrual flow. All of the patients were requested to compile a pictorial blood loss assessment chart each month. They underwent clinical and transvaginal ultrasound examinations 3, 6, and 12 months after IUD insertion. Menstrual pattern; serum hemoglobin, ferritin, and iron level changes. One patient experienced IUD expulsion 2 months after device insertion and another requested removal of the IUD 4 months after insertion because of persistent irregular blood loss. Six months after IUD insertion, amenorrhea was observed in 2 patients and oligomenorrhea in another, spotting occurred occasionally in 7, and 13 had scanty but regular flow. One year of follow-up has been completed by the remaining 23 women: 2 with amenorrhea, 3 with oligomenorrhea, 2 with spotting, and 16 with regular flows. Significant increases in hemoglobin, hematocrit, and serum ferritin have been observed, but the lipid metabolism and clotting variables have remained unchanged. Our findings indicate that marked and safe relief from adenomyosis-associated menorrhagia can be obtained with the use of a levonorgestrel-releasing IUD.
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              Added health benefits of the levonorgestrel contraceptive intrauterine system and other hormonal contraceptive delivery systems.

              Ian S. Fraser (2013)
              It has been recognized for well over half a century that hormonal preparations designed as contraceptives are also capable of offering health benefits through the treatment and prevention of benign gynecological disease and even some systemic conditions. Increasing attention is now being paid to the extent and detail of such added health benefits, and it is becoming clear that the long-acting, low-dose, hormonal contraceptive delivery systems may offer particular advantages in this regard.
              Article 0 comments Cited 10 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Princ Pract
                Journal ID (iso-abbrev): Med Princ Pract
                Journal ID (publisher-id): MPP
                Title: Medical Principles and Practice
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Print): 1011-7571
                ISSN (Electronic): 1423-0151
                Publication date (Print): September 2013
                Publication date (Electronic): 19 June 2013
                Publication date PMC-release: 19 June 2013
                Volume: 22
                Issue: 5
                Pages: 480-483
                Affiliations
                [1] aDepartment of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong Province, PR China, Japan
                [2] bDepartment of Physiology, Faculty of Pharmacy, Meijo University, Meijo, Japan
                Author notes
                *Kun Song, MD, PhD, Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong Province (PR China), E-Mail songkun2001226@ 123456yahoo.com.cn
                Article
                Publisher ID: mpp-0022-0480
                DOI: 10.1159/000351431
                PMC ID: 5586783
                PubMed ID: 23796720
                SO-VID: 0b315bbd-50ed-4ac6-95c6-35ca1a9ad70e
                Copyright © Copyright © 2013 by S. Karger AG, Basel
                License:

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.

                History
                Date received : 18 October 2012
                Date accepted : 18 April 2013
                Page count
                Figures: 2, Tables: 1, References: 7, Pages: 4
                Categories
                Subject: Original Paper

                Keywords: adenomyosis,gonadotropin-releasing hormone analog,levonorgestrel-releasing intrauterine system
                Data availability:
                Keywords: adenomyosis, gonadotropin-releasing hormone analog, levonorgestrel-releasing intrauterine system

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