Aim Abnormal uterine bleeding (AUB) is a common gynaecological complaint affecting around 10–30% women during reproductive years. It adversely affects a woman’s life, leading to psychological, medical, social and sexual problems. We aim to study the efficacy of a levonorgestrel intrauterine system (LNG-IUS) in 100 women suffering from AUB.
Methodology A retrospective study was carried out at a private nursing home in Mumbai over a period of 4 years. A total of 100 patients aged 30 years to 50 years (average age = 42.9 years) who underwent LNG-IUS insertion for abnormal uterine bleeding were studied. Cases were evaluated according to clinical findings, hemogram and transvaginal ultrasound. The women were called for follow-up at 1 week, 1 month, 6 months, 1 and 2 years to analyse type and amount of bleeding and development of amenorrhea.
Results At the end of 6 months, 75% patients experienced decreased menstrual blood loss. Five patients underwent removal of the LNG-IUS at the end of 6 months as they experienced no relief of symptoms. At the end of 2 years, 95% patients were fully satisfied with the LNG-IUS insertion.
Conclusion A levonorgestrel intrauterine system significantly reduces bleeding in menorrhagia due to benign causes and is found to be highly effective in the management of various gynaecological pathologies such as endometrial polyps, adenomyosis and endometrial hyperplasia when insertion perfomed after dilatation and curettage/polypectomy. It has proven to be superior to various surgical and other non-surgical treatment modalities.
Keywords : Abnormal uterine bleeding · Levonorgestrel intrauterine system · PALM-COEIN classification · Adenomyosis · Endometrial hyperplasia · Polyp
Abnormal uterine bleeding (AUB) is a common gynaecological complaint affecting around 10–30% women during reproductive years. It adversely affects a woman’s life, leading to psychological, medical, social and sexual problems. It may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy [1, 2]. It could be caused by both structural and nonstructural causes and is a major cause of distress and inconvenience to women. The recent PALM-COEIN classification given by FIGO (the International Federation of Gynaecologists and Obstetricians) divides AUB as being caused by either organic lesions (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia) or functional disturbances (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified) [2].
Several medical and surgical modalities have been suggested for the management of symptoms associated with AUB, including heavy menstrual bleeding, pain associated with menstruation, irregular cycles, etc. Depending on patient history, bleeding patterns and associated conditions/ risk factors, several medical modalities are available. These include hormonal modalities such as combined oral contraceptive regimens, progestin only regimens, injectable and implantable hormone therapies, procoagulants such as tranexemic acid and hormonal and non-hormonal intrauterine devices (IUDs) [3, 4]. For patients with AUB refractory to medical management, and especially those with underlying structural lesions causing and/or aggravating these symptoms, surgical interventions can be performed.
A levonorgestrel intrauterine system is a progestin-based IUD which is classified as a long active reversible contraception. Beside its use as a contraceptive, these progestin IUDs are also used for long-term medical management of AUB and other gynaecological disorders. Several studies have shown the superiority of LNG-IUS compared to other treatment modalities (both surgical and non-surgical) in terms of both higher efficacy and lower side effects [5, 6]. The LNGIUS used in this study contains 52 mg of levonorgestrel in its stem. The hormone release rate is 20 μg/day and is considered to be an effective contraception for up to 5–7 years [7]. Here, we study the efficacy of a levonorgestrel intrauterine system (LNG-IUS) in 100 women suffering from AUB. The efficacy is studied in terms of relief of symptoms, quality of life and side effects associated with it.
