Disfonksiyonel uterin kanama tedavisinde Levonorgestrel Salgılayan İntrauterin Sistem ve oral Traneksamik asit etkinliğinin karşılaştırılması

Öz

Amaç: Disfonksiyonel uterin kanama (DUK) tedavisinde LNG-IUS(Levonergestrel salgılayan intrauterin sistem) ve oral traneksamik asit menstrüel kan kaybını azaltmadaki etkinliği, yan etkiler ve tedaviye devam açısından karşılaştırılmıştır. Gereç ve Yöntem: Çalışmaya DUK tanısı alıp LNG-IUS uygulanan ve 3 gr/gün oral traneksamik asit kullanan toplam 60 hasta dahil edildi. Hastaların gözlemsel kanama skorlama sistemi ile hesaplanmış tedavi öncesi kanama skorları(PBAS), kanamalı gün sayıları ve hemoglobin değerleri kaydedildi. Hastalar tedavinin 3 ve 6. aylarında çağrılarak kanama skorları(PBAS), kanamalı gün sayıları, hemoglobin değerleri kaydedilip, yan etkiler açısından ayrıntılı sorgulandı. Bulgular: İki gruptada 3 ve 6. ayda kanamalı gün sayısındaki azalma istatiksel olarak anlamlıdır (p<0,05). İki grup arasında kanamalı gün sayısındaki azalma açısından 3. ayda istatistiksel anlamlı farklılık yokken(p>0,05), 6. ayda LNG-IUS grubundaki azalma traneksamik asit grubundaki azalmadan daha fazladır (p<0,05). Traneksamik asit grubunda PBAS’de 3. ayda %55 azalma 6. ayda %62 azalma izlensede, bu azalmalar istatiksel olarak birbirinden farklı değildir (p>0,05). LNG-IUS grubunda PBAS’de 3. ayda %87,5 ve 6. ayda %90,5 azalma olup, 6. aydaki azalma istatiksel olarak daha fazladır (p<0,05). Ancak iki grup arasında kanama miktarındaki azalma LNG-IUS grubunda daha fazla olup bu azalma istatiksel olarakta anlamlıdır (p<0,05). LNG-IUS grubunda hemoglobin düzeyinde 3. ayda %5,6, 6. ayda %9,4 artış izlenirken, traneksamik asit grubunda 3. ayda %3,6, 6. ayda %4,5 artış izlenmiş olup, artış açısından iki grup istatiksel olarak benzerdir (p>0,05). LNG-IUS uygulanan gruptaki 3. ayın sonunda 10(%40) hastada mastalji, 6. ayda 10(%43) hastada oligo-amenore en sık yan etki idi. Bu grupta 6 ay sonunda tedaviye devam oranı %78 iken, 2(%6,6) hasta yan etkiler nedeniyle tedaviyi bıraktı. Traneksamik asit grubunda 6 ay sonunda tedaviye devam oranı %63 iken hiçbir hasta yan etkiler nedeniyle tedaviyi bırakmadı. Sonuç: LNG-IUS DUK tedavisinde kan kaybını azaltmada traneksamik asitten daha etkin olsada menstrüel siklus paternindeki radikal değişim ve sistemik yan etkiler tedaviyi sürdürmemenin en sık nedenidir. Traneksamik asit fertiliteyi etkilemeden, siklus paternlerini bozmadan ve daha iyi tolere edilen yan etkilerle kan kabında azalma sağlar.

Anahtar Kelimeler

• disfonksiyonel uterin kanama
• Levonergestrel salgılayan intrauterin sistem
• traneksamik asit

Comparison of the Levonorgestrel-releasing intrauterine system and oral tranexamic acid in the treatment of dysfunctional uterine bleeding

Abstract

Materials and Method: 60 patients who were diagnosed with DUB and were treated with either oral tranexamic acid 3gr/day or LNG-IUS were included in the study. Bleeding scores(PBAS), duration of bleeding and haemoglobin values before the therapy were recorded. Patients were evaluated again for the same parameters and possible side effects on the 3rd and 6th months of therapy. Results: Decrease in duration of bleeding on the 3rd and 6th months of therapy were statistically significant in both groups(p<0,05). While there was no statistically significant difference on the decrease in the duration of bleeding on the 3rd month of therapy(p>0,05), the decrease was more significant in the LNG-IUS group than the tranexamic acid group on the 6th month(p<0,05). In the tranexamic acid group, PBAS dropped by 55 % on the 3rd month, and 62% on the 6th month, but these changes were not significantly different from each other(p>0,05). In the LNG-IUS group, PBAS decreased by 87.5 % on the 3rd month, and 90.5% on the 6th month, and these changes were statistically significant(p<0,05). However, the decrease in the amount of bleeding was significantly more in the LNG-IUS group than the tranexamic acid group(p<0,05). While haemoglobin levels increased 5.6% on the 3rd month and 9.4% on the 6th month in the LNG-IUS group, they increased 3.6% on the 3rd month and 4.5% on the 6th month in the tranexamic acid group. In the LNG-IUS group the most common complaint was mastalgia on the 3rd month of therapy(40%, 10 patients), and oligomenorrhea-amenorrhea on the 6th month (43%, 10 patients). After 6 months, 78% of patients continued the treatment, while 2 patients(6.6%) quit the therapy because of the side effects. In the tranexamic acid group, the compliance rate was 63%, and none of the patients had discontinued the therapy due to side effects. Conclusion: Even though LNG-IUD is more effective than tranexamic acid in reducing blood loss in DUB patients, the major change in the menstrual cycle pattern and systemic side effects are the most common reasons for discontinuing therapy. Tranexamic acid reduces blood loss while conserving cycle patterns and fertility, and is better tolerated.

Keywords

• Disfunctional uterine bleeding
• Levonorgestrel-releasing intrauterine system
• Tranexamic acid

Kaynakça

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