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

Yıl 2020, , 159 - 164, 30.09.2020

Emre Erdoğdu , Necdet Suer

https://doi.org/10.16948/zktipb.771644

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

Öz

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.

Anahtar Kelimeler

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

Teşekkür

lşlş

Kaynakça

• Referans1 Fraser IS, Inceboz US. Defining disturbances of the menstrual cycle. In: O’Brien S, Maclean A, Cameron I, eds. Disorders of themenstrual cycle. London: RCOG Press, 2000; 141–52.
• Referans2 Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994; 83: 549–55.
• Referans3 Kjerulff KH, Langenberg PW, Rhodes JC, Harvey LA, Guzinski GM, Stolley PD. Effectiveness of hysterectomy. Obstet Gynecol 2000; 95: 319–26.
• Referans4 Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women’s Health Study: I. Outcomes of hysterectomy. Obstet Gynecol 1994; 83:556–65.
• Referans5 Brooks PG, Clouse J, Morris LS. Hysterectomy vs. resectoscopic endometrial ablation for the control of abnormal uterine bleeding. A cost comparative study. J Reprod Med 1994; 39: 755–60.
• Referans6 Sandra E Brooks 1, C Daniel Mullins, Chuanfa Guo, T Timothy Chen, James F Gardner, Claudia R Baquet. Resource utilization for patients undergoing hysterectomy with or without lymph node dissection for` endometrial cancer. Gynecol Oncol 2002; 85: 242–9.
• Referans7 Broder MS, Kanouse DE, Mittman BS, Bernstein SJ. The appropriateness of recommendations for hysterectomy. Obstet Gynecol 2000; 95: 199–205.
• Referans8 Janssen CA, Scholten PC, Heintz APM. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Obstet Gynecol 1995; 85: 977–82.
• Referans9 Lobo RA, Picker JH, Wild RA, Hirvonen E. Metabolic impact of adding medroxyprogesterone acetate to conjugated estrogen therapy in postmenopausal women. Obstet Gynecol 1994; 84: 987–95.
• Referans10 Barrett-Connor E, Slone S, Greendale G, Kritz-Silverstein D, Espeland M, Johnson SR et al. The Postmenopausal Estrogen/Progestin Intervention Study; primary outcome in adherent women. Maturitas 1997; 27: 261–74.
• Referans11 Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. Br Med J 1996; 313: 579–82.
• Referans12 Callender ST, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid. A double-blind trial. Br Med J 1970; 4: 214–16.
• Referans13 Coulter A, Kelland J, Peto V, Rees MC. Treating menorrhagia in primary care. An overview of drug trials and a survey of prescribing practice. Int J Technol Assess Health Care 1995; 11: 456–71.
• Referans14 Milsom I, Anderson K, Andersch B, Rybo G. A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia. Am J Obstet Gynecol 1991; 164: 879–83.
• Referans15 Kriplani A, Kulshrestha V, Agarwal N, Diwakar S. Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate. J Obstet Gynaecol 2006; 26: 673–8.
• Referans16 Luukkainen T, Pakarinen P, Toivonen J. Progestin releasing intrauterine systems. Semin Reprod Med 2001; 19: 355–63.
• Referans17 Luukkainen T, Allonen H, Haukkamaa M, Holma P, Pyörälä T, Terho J et al. Effective contraception with the levonorgestrel-releasing intrauterine device. 12 month report of a European multicenter study. Contraception 1987; 36: 169–79.
• Referans18 Stewart A, Cummins C, Gold L. The effectiveness of the levonorgestrel- releasing intrauterine system in menorrhagia: a systematic review. Br J Obstet Gynaecol 2001; 108: 74–86.
• Referans19 Milsom I, Anderson K, Andersch B, Rybo G. A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia. Am J Obstet Gynecol 1991; 164: 879–83.
• Referans20 Gleeson NC, Buggy F, Sheppard BL, Bonnar J. The effect of tranexamic acid on measured menstrual loss and endometrial fibrinolytic enzymes in dysfunctional uterine bleeding. Acta Obstet Gynecol Scand 1994; 73: 274–7.