Evaluation of Intrauterine Devices With Levonorgestrel in Patients With Heavy Menstrual Bleeding According to the Palm-Coein Classification System

Abstract

Aim: To evalute the efficacy of a levonorgestrel-releasing intrauterine device for the treatment of patients with heavy menstrual bleeding based on the PALM-COEIN polyp; adenomyosis; leiomyoma; malignancy; hyperplasia-coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; not yet classified system.Material and Methods: A retrospective study was performed of 110 cases that were grouped according to the PALM-COEIN classification system as those with or without structural abnormalities. For the 84 cases who completed 12 months of treatment, menstrual patterns, pictorial blood assessment chart PBAC scores, hemoglobin Hb values, and endometrial thickness changes were examined after 1,6 and 12 months. Independent sample t-tests,repeated-measures ANOVA, post-hoc Bonferroni adjustment and chi-squared tests were used for statistical evaluation.Results: After 12 months of treatment, 73.8% of cases achieved a normal menstrual pattern. The PBAC score decreased by 80.6% in the COEIN group and 83.9% in the PALM group. The PBAC scores and endometrial thicknesses were decreased p0.05 .Conclusion: The levonorgestrel-releasing intrauterine device has high levels of effectiveness in cases with or without structural uterine abnormalities.

Keywords

• Levonorgestrel,intrauterine devices,menorrhagia,pictorial blood assessment chart,PALM-COEIN.

Ağır Menstrüel Kanamalı Olgularda Levonorgestrelli İntrauterin Araç Etkinliğinin Palm- Coein Sınıflama Sistemine Göre Değerlendirilmesi

Abstract

Amaç: Ağır menstruel kanamalı olguların tedavisinde levonorgestrel salgılayan intrauterin araç etkinliğinin PALM-COEİN polip; adenomiyozis; leiomyoma; malignensi; koagülopati; endometrial hiperplazi; ovulatuar disfonksiyon; iatrojenik; henüz sınıflandırılmamış sistemine göre etkinliğini belirlemek.Gereç ve Yöntemler: Yapısal anomalisi bulunup bulunmamasına göre PALM-COEİN sınıflama sistemi ile gruplandırılan 110 olgu retrospektif olarak incelendi. Oniki aylık tedaviyi tamamlayan 84 olgunun menstruel paternleri, ‘pictorial blood assessment chart PBAC skorları, hemoglobin Hb değerleri ve endometrial kalınlıklarındaki 1, 6 ve 12. aydaki değişikleri incelendi. İstatistiksel değerlendirmede Independent sample t-tests, repeated-measures ANOVA, post-hoc Bonferroni düzeltmesi ve ki-kare testleri kullanıldı.Bulgular: Tedaviye başlangıçtan 12 ay sonra olguların % 73.8’i normal menstruel paterne kavuştu. PBAC skoru COEIN grubunda % 80.6, PALM grubunda ise % 83.9 azaldı. Tedaviye başladıktan 12 ay sonra her iki grupta PBAC skoru ve endometrial kalınlık azalırken p0.05 .Sonuç: Levonorgestrel salgılayan intrauterin araçlar yapısal uterin anomalisi olsun olmasın yüksek oranda etkinlik göstermektedir.

Keywords

• Levonorgestrel,intrauterin araç,menoraji,pictorial blood assessment chart,PALM-COEIN.

References

1. Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health 2007;10:183-94.
2. Gokyildiz S, Aslan E, Beji NK, Mecdi M. The Effects of Menorrhagia on Women’s Quality of Life: A Case-Control Study. ISRN Obstet Gynecol 2013;8:918179.
3. Palacios S. The management of iron deficiency in menometrorrhagia. Gynecol Endocrinol 2011;27:1126-30.
4. Marret H, Fauconnier A, Chabbert-Buffet N, Cravello L, Golfier F, Gondry J et al Clinical practice guidelines on menorrhagia: management of ab- normal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol 2010;152:133-7.
5. Milsom I. The levonorgestrel-releasing intrauterine system as an al- ternative to hysterectomy in peri-menopausal women. Contraception 2007;75:152-4.
6. Lee BS, Ling X, Asif S, Kraemer P, Hanisch JU, Inki P. Levonorgestrel-re- leasing intrauterine system versus conventional medical therapy for heavy menstrual bleedingin the Asia-Pacific region. Int J Obstet Gynecol 2013;121:24-30.
7. Hurskainen R, Paavonen J. Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding. Curr Opin Obstet Gynecol 2004;16:487-90.
8. Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011;11:3-13.

9. Committee on Practice Bulletins—Gynecology.Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Ob- stet Gynecol 2012;120:197-206.
10. Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynecol 1990;97:734-9.
11. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prev- alence of anaemia, WHO Vitamin and Mineral Nutrition Information Sys- tem, 1993-2005. Public Health Nutr 2009;12:444-54.
12. Kriplani A, Singh BM, Lal S, Agarwal N. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet 2007;97:190-4.
13. Mercorio F, De Simone R, Di Spiezio Sardo A, Cerrota G, Bifulco G, Va- nacore F, Nappi C. The effect of a levonorgestrel-releasing intrauterine device in the treatment of myoma-related menorrhagia. Contraception 2003;67:277-80.
14. Kriplani A, Awasthi D, Kulshrestha V, Agarwal N. Efficacy of the levo- norgestrel-releasing intrauterine system in uterine leiomyoma. Int J Gy- naecol Obstet 2012;116:35-8.
15. Chattopdhyay B, Nigam A, Goswami S, Chakravarty PS. Clinical out- come of levonorgestrel intra-uterine system in idiopathic menorrhagia. Eur Rev Med Pharmacol Sci 2011;15:764-8.
16. Peng FS, Wu MY, Yang JH, Chen SU, Ho HN, Yang YS. Insertion of the Mirena intrauterine system for treatment of adenomyosis-associated menorrhagia: a novel method. Taiwan J Obstet Gynecol 2010;49:160-4.
17. Desai RM. Efficacy of levonorgestrel releasing intrauterine system for the treatment of menorrhagia due to benign uterine lesions in perimenopaus- al women. J Midlife Health 2012;3:20-3.
18. Varma R, Soneja H, Bhatia K, Ganesan R, Rollason T, Clark TJ, Gupta JK. The effectiveness of a levonorgestrel-releasing intrauterine system (LNG- IUS) in the treatment of endometrial hyperplasia--a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol 2008;139:169-75.
19. Xiao B, Wu SC, Chong J, Zeng T, Han LH, Luukkainen T. Therapeutic ef- fects of the levonorgestrel-releasing intrauterine system in the treatment of idiopathic menorrhagia. Fertil Steril 2003;79:963-9.