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DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ

Year 2013, Volume: 16 Issue: 1, 5 - 9, 01.01.2013

H. Mesut Özsoy

Abstract

Objektif: Disfonksiyonel uterin kanama tedavisinde levonorgestrel
salınımlı intrauterin sistemin (LNG-IUS, Mirena) etkinlik, kabul
edilebilirlik ve olası yan etkilerinin değerlendirilmesi.
Planlama: Prospektif, tanımlayıcı, non-komperatif çalışma.
Ortam: Başkent Üniversitesi İzmir Zübeyde Hanım Hastanesi,
Kadın Hastalıkları ve Doğum Kliniği
Hastalar: Medikal tedavilere cevap vermemiş, disfonksiyonel
uterin kanama tanısı alan 40 hasta.
Girişim: Menstrüasyonun ikinci veya üçüncü günü levonorgestrel
salınımlı intrauterin aparat yerleştirildi.
Değerlendirme Parametreleri: Hastalar altıncı ay ve birinci yılın
sonunda kanama paternleri, hemoglobin değerleri, endometrial kalınlık
ölçümleri ve subjektif menstrüel kan kaybı parametreleri açısından
değerlendirildi. Yan etkilerin yanında tedaviye uyum süreci de değerlendirildi.
Sonuçlar: Hastaların yaşları 29 ile 48 arasında değişmekte olup
yaş ortalaması 40,1±4,5 olarak saptandı. Altıncı ayın sonunda hastaların
%85’i (34/40) tedaviye cevap vermişti, bir yıl sonunda ise tedavi
başarı oranı %97.2 (35/36) idi. Hemoglobin değerlerinde ve endometrial
kalınlıkta altıncı ve on ikinci aylarda istatistiksel olarak anlamlı
fark saptandı (p<0.001). Subjektif menstrüel kan kaybı altıncı ayda
%70, bir yılsonunda ise %90 azalmıştı (p<0.001). Toplam 4 hastaya
(%10) histerektomi yapıldı.
Yorum: Fertilitenin korunamadığı histerektomi ve endometrial yı-
kım tekniklerine göre hem daha non-invazif olması hem de kontrasepsiyonu
sağlaması gibi özellikleri de göz önüne alınırsa, disfonksiyonel
uterin kanamanın medikal tedavisinde levonorgestrel salınımlı
intrauterin sistem etkili ve kabul edilebilir bir yöntemdir.

Keywords

Levonorgestrel Salınımlı İntrauterin Sistem Disfonksiyonel Uterin Kanama Menoraji.

References

  • 1. Stewart A, Cummins C, Gold L, Jordan R, Phillips W. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG. 2001;108(1):74-86.
  • 2. Monteiro I, Bahamondes L, Diaz J, Perrotti M, Petta C. Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: a pilot study. Contraception. 2002;65(5):325-8.
  • 3. 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(3):190-4.
  • 4. Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivelä A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357(9252):273-7.
  • 5. Sculpher MJ, Dwyer N, Byford S, Stirrat GM. Randomised trial comparing hysterectomy and transcervical endometrial resection: effect on health related quality of life and costs two years after surgery. Br J Obstet Gynaecol. 1996;103(2):142-9.
  • 6. Concin H, Bösch H, Hintermüller P, Hohlweg T, Mursch-Edlmayr G, Pinnisch B, Schmidl-Amann S, Schulz-Greinwald G, Unterlerchner D, Wagner T, Mattle V, Wildt L, Fiala C. Use of the levonorgestrel-releasing intrauterine system: an Austrian perspective. Curr Opin Obstet Gynecol. 2009;21 Suppl 1:S1-9.
  • 7. Vercellini P, Viganò P, Somigliana E. The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis. Curr Opin Obstet Gynecol. 2005;17(4):359-65.
  • 8. Bragheto AM, Caserta N, Bahamondes L, Petta CA. Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception. 2007;76(3):195-9.
  • 9. Jones RL, Critchley HO. Morphological and functional changes in human endometrium following intrauterine levonorgestrel delivery. Hum Reprod. 2000;15 Suppl 3:162-72.
  • 10. Nilsson CG, Haukkamaa M, Vierola H, Luukkainen T. Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD. Clin Endocrinol (Oxf). 1982;17(6):529-36.
  • 11. Hurskainen R, Salmi A, Paavonen J, Teperi J, Rutanen E. Expression of sex steroid receptors and Ki-67 in the endometria of menorrhagic women: effects of intrauterine levonorgestrel. Mol Hum Reprod. 2000;6(11):1013- 8.
  • 12. Rutanen E, Hurskainen R, Finne P, Nokelainen K. Induction of endometrial plasminogen activator-inhibitor 1: a possible mechanism contributing to the effect of intrauterine levonorgestrel in the treatment of menorrhagia. Fertil Steril. 2000;73(5):1020-4.
  • 13. Pakarinen P, Luukkainen T, Laine H, Lähteenmäki P. The effect of local intrauterine levonorgestrel administration on endometrial thickness and uterine blood circulation. Hum Reprod. 1995;10(9):2390-4.
  • 14. Orbo A, Arnes M, Pettersen I, Larsen K, Hanssen K, Moe B. Down-regulated progesterone receptor A and B coinciding with successful treatment of endometrial hyperplasia by the levonorgestrel impregnated intrauterine system. Acta Obstet Gynecol Scand. 2010;89(11):1438-46.
  • 15. Lee SY, Kim MK, Park H, Yoon BS, Seong SJ, Kang JH, Jun HS, Park CT. The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol. 2010;21(2):102-5.

Year 2013, Volume: 16 Issue: 1, 5 - 9, 01.01.2013

H. Mesut Özsoy

Abstract

Objective: To evaluate the efficacy, acceptability, and possible side
effects of a levonorgestrel-releasing intrauterine system (LNG-IUS,
Mirena®) for dysfunctional uterine bleeding.
Design: Descriptive, prospective, and a non-comparative study.
Setting: Başkent Üniversitesi İzmir Zübeyde Hanım Hastanesi,
Kadın Hastalıkları ve Doğum Kliniği
Patients: 40 women who presented with dysfunctional uterine
bleeding after medical therapies had failed.
Interventions: A 20μg/day levonorgestrel-releasing intrauterine
system was inserted during menstrual period.
Main outcome measures: Menstrual patterns were assessed; hemoglobin
concentrations and endometrial thickness were measured at
preinsertion and at 6 and 12 months of use.
Results: At the end of the sixth and twelfth month, menorrhagia
was cured in 85% (34/40) and 97.2% (35/36) of patients, respectively.
There was a significant difference in hemoglobin values and endometrial
thickness at the end of the sixth month and first year (p<0.001).
The subjective blood loss reduction was considerable as well, with
70% decrease at sixth month and 90% decrease at twelfth month
(p<0.001).
Conclusions: Considering the invasive endometrial destruction
techniques and hysterectomy in which fertility is not preserved, levonorgestrel-releasing
intrauterine system is an effective and well accepted
option overall for the medical management of dysfunctional uterine
bleeding.

Keywords

Levonorgestrel-releasing Intrauterine System Dysfunctional Uterine Bleeding Menorrhagia

References

  • 1. Stewart A, Cummins C, Gold L, Jordan R, Phillips W. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG. 2001;108(1):74-86.
  • 2. Monteiro I, Bahamondes L, Diaz J, Perrotti M, Petta C. Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: a pilot study. Contraception. 2002;65(5):325-8.
  • 3. 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(3):190-4.
  • 4. Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivelä A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357(9252):273-7.
  • 5. Sculpher MJ, Dwyer N, Byford S, Stirrat GM. Randomised trial comparing hysterectomy and transcervical endometrial resection: effect on health related quality of life and costs two years after surgery. Br J Obstet Gynaecol. 1996;103(2):142-9.
  • 6. Concin H, Bösch H, Hintermüller P, Hohlweg T, Mursch-Edlmayr G, Pinnisch B, Schmidl-Amann S, Schulz-Greinwald G, Unterlerchner D, Wagner T, Mattle V, Wildt L, Fiala C. Use of the levonorgestrel-releasing intrauterine system: an Austrian perspective. Curr Opin Obstet Gynecol. 2009;21 Suppl 1:S1-9.
  • 7. Vercellini P, Viganò P, Somigliana E. The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis. Curr Opin Obstet Gynecol. 2005;17(4):359-65.
  • 8. Bragheto AM, Caserta N, Bahamondes L, Petta CA. Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception. 2007;76(3):195-9.
  • 9. Jones RL, Critchley HO. Morphological and functional changes in human endometrium following intrauterine levonorgestrel delivery. Hum Reprod. 2000;15 Suppl 3:162-72.
  • 10. Nilsson CG, Haukkamaa M, Vierola H, Luukkainen T. Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD. Clin Endocrinol (Oxf). 1982;17(6):529-36.
  • 11. Hurskainen R, Salmi A, Paavonen J, Teperi J, Rutanen E. Expression of sex steroid receptors and Ki-67 in the endometria of menorrhagic women: effects of intrauterine levonorgestrel. Mol Hum Reprod. 2000;6(11):1013- 8.
  • 12. Rutanen E, Hurskainen R, Finne P, Nokelainen K. Induction of endometrial plasminogen activator-inhibitor 1: a possible mechanism contributing to the effect of intrauterine levonorgestrel in the treatment of menorrhagia. Fertil Steril. 2000;73(5):1020-4.
  • 13. Pakarinen P, Luukkainen T, Laine H, Lähteenmäki P. The effect of local intrauterine levonorgestrel administration on endometrial thickness and uterine blood circulation. Hum Reprod. 1995;10(9):2390-4.
  • 14. Orbo A, Arnes M, Pettersen I, Larsen K, Hanssen K, Moe B. Down-regulated progesterone receptor A and B coinciding with successful treatment of endometrial hyperplasia by the levonorgestrel impregnated intrauterine system. Acta Obstet Gynecol Scand. 2010;89(11):1438-46.
  • 15. Lee SY, Kim MK, Park H, Yoon BS, Seong SJ, Kang JH, Jun HS, Park CT. The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol. 2010;21(2):102-5.
There are 15 citations in total.

Details

Other ID JA25NY84JZ
Journal Section Research Article
Authors

H. Mesut Özsoy This is me

Publication Date January 1, 2013
Submission Date January 1, 2013
Published in Issue Year 2013 Volume: 16 Issue: 1

Cite

APA Özsoy, H. M. (2013). DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ. Türk Jinekolojik Onkoloji Dergisi, 16(1), 5-9.
AMA Özsoy HM. DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ. TRSGO Dergisi. January 2013;16(1):5-9.
Chicago Özsoy, H. Mesut. “DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ”. Türk Jinekolojik Onkoloji Dergisi 16, no. 1 (January 2013): 5-9.
EndNote Özsoy HM (January 1, 2013) DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ. Türk Jinekolojik Onkoloji Dergisi 16 1 5–9.
IEEE H. M. Özsoy, “DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ”, TRSGO Dergisi, vol. 16, no. 1, pp. 5–9, 2013.
ISNAD Özsoy, H. Mesut. “DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ”. Türk Jinekolojik Onkoloji Dergisi 16/1 (January 2013), 5-9.
JAMA Özsoy HM. DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ. TRSGO Dergisi. 2013;16:5–9.
MLA Özsoy, H. Mesut. “DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ”. Türk Jinekolojik Onkoloji Dergisi, vol. 16, no. 1, 2013, pp. 5-9.
Vancouver Özsoy HM. DİSFONKSİYONEL UTERİN KANAMA TEDAVİSİNDE LEVONORGESTREL SALINIMLI İNTRAUTERİN SİSTEMİN ROLÜ. TRSGO Dergisi. 2013;16(1):5-9.