Intrauterine progestogen is effective in symptom control throughout the 3 years on the device, and discontinuation is greatest between 3 and 6 months. For those patients with improvement in symptoms, it is an acceptable long-term alternative.
The levonorgestrel intrauterine system is an effective hormonal option for treating symptomatic endometriosis (minimal to moderate). It also alters the American Fertility Society staging of disease. With a continuation rate of 68% after 6 months, it has the potential for providing long-term therapy in a substantial number of sufferers, although this would require further study and verification.
This paper presents a 5-year follow-up of a randomized, controlled trial, which compared microwave endometrial ablation (MEA) with transcervical resection of the endometrium (TCRE) for women with heavy menstrual bleeding. Two hundred sixty-three women were randomized to receive either MEA (n ϭ 129) or TCRE (n ϭ 134). For the current study, participants who were at least 60 months postprocedure were sent a questionnaire concerning satisfaction with and acceptability of their treatment method, menstrual status, changes in health-related quality of life, and any further surgery received. This was the same questionnaire that had been sent at 1-and 2-years of follow-up.Two hundred thirty-six of the original 263 study participants (90%) returned a completed questionnaire, including 116 MEA patients and 120 TCRE patients. Total or general satisfaction was reported by significantly more of those who underwent MEA compared with those who had TCRE (86% vs. 74%). Similarly, 83% and 75%, respectively, reported a cure or acceptable improvement in their symptoms, 97% and 91% expressed overall treatment acceptance, and 97% and 89% said that they would recommend the procedure to a friend. Both groups had similar, significant improvement in bleeding and pain scores, and 96% overall reported amenorrhea or lighter periods. Significantly more women in the TCRE group experienced dyspareunia compared with the MEA group (11% vs. 6%, respectively). Premenstrual symptoms improved significantly for both groups.Quality-of-life scores were improved for all participants. Disruptions to work or leisure activities were significantly lower in both treatment groups.In all, 24% of the patients who had MEA and 28% of those who had TCRE had undergone further gynecologic surgery in the follow-up period. This includes a 16% hysterectomy rate for the MEA cohort and 25% hysterectomy rate for women who had TCRE. Nearly all of the 20 hysterectomies among women in the MEA arm occurred within 24 months of the initial procedure. Reasons for hysterectomy were bleeding, combined bleeding and dysmenorrhea, cyclic pain, and miscellaneous conditions, including 1 woman in the TCRE arm who was operated on for endometrial carcinoma. GYNECOLOGY Volume 60, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT The authors performed a medical chart review of all women diagnosed with atypical squamous cells of undetermined significance (ASCUS) between July 2002 and February 2004 to determine the presence of oncogenic human papillomavirus (HPV) according to patient age. Other risk factors were also noted. Cervical smears were evaluated using fluid-based thin-layer cytology (PreservCyt; Cytyc Corp., Marlborough, MA). Office Gynecology 435 436 Obstetrical and Gynecological Survey ABSTRACT This paper presents a series of 970 women who reported to the Chronic Pelvic Pain Clinic at the University of North Carolina between July 1993 and December 2000 with pelvic pain of at least 6 months duration. The authors investigated the prevalence of irritable bowel syndrome (IBS) in th...
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