Am J Obstet Gynecol. 2008
Apr;198(4):373.e1-7.
Clinical effects of the levonorgestrel-releasing
intrauterine device in patients with adenomyosis.
Cho S, Nam A, Kim H, Chay D, Park K, Cho DJ,
Park Y, Lee B.
Department of Obstetrics and Gynecology,
Yongdong Severance Hospital, Yonsei University
College of Medicine, Seoul, Korea.
Objectives:
The aim of this study was to evaluate
the long-term clinical effects of a
levonorgestrel-releasing intrauterine device
(LNG-IUD) on adenomyosis.
Study Design:
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.
Results:
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).
Conclusion:
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.
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