Objective To assess the effect of a levonorgestrel releasing intrauterine system in the management of Design A prospective study.Setting A district general hospital in South Wales.Methods Fifty women with a failed trial of medical therapy and awaiting hysterectomy or transcervical resection of the endometrium (TCRE) were treated with a levonorgestrel intrauterine system. The menstrual loss was estimated using a modified pictorial chart together with a full blood count and ferritin measurement preinsertion and at three and six to nine months postinsertion.
ResultsThe menstrual loss was reduced to acceptable levels in 37 women at three months and a further four by six to nine months. In all, 41 patients were taken off the waiting list for surgery, four of whom became amenorrhoeic. There was no significant change in full blood count nor ferritin measurement despite unscheduled bleeding for six to eight weeks postinsertion. Fifty-six percent of patients noticed considerable improvement or cure of their premenstrual syndrome symptoms; 80% noted a reduction in dysmenorrhoea.
ConclusionThe levonorgestrel releasing intrauterine system is an effective nonsurgical treatment for the management of menorrhagia and dysmenorrhoea that has additional benefit as a contraceptive and in relieving premenstrual syndrome.menorrhagia.
Four cases are presented here of patients who had total abdominal hysterectomy and bilateral salpingooophorectomy for severe endometriosis. All were eventually placed on unopposed oestrogen replacement therapy, two immediately and the other two after a few months. All subsequently developed recurrence of their endometriosis whilst on oestrogen therapy, one developing an endometroid carcinoma. All required surgery and three were placed on continuous oestrogen/progestogen preparation or alternatively tibolone (which has oestrogenic, progestogenic and androgenic properties) postoperatively. No further recurrence of their disease occurred. The literature was reviewed regarding oestrogen therapy for women who have had bilateral oophorectomy. There were various suggestions as to management but no report on using continuous oestrogen/ progestogen or tibolone. We suggest this as a logical form of replacement therapy for patients who have bilateraloophorectomy for severe endometriosis, as unopposed oestrogen therapy can cause recurrence.
Percutaneous oestradiol replacement therapy prevents menopausal bone loss and is associated with a sustained and significant increase in total body calcium, spinal trabecular bone mineral density and radial bone mineral content over a 3-year treatment period. Oestradiol implants thus have skeletal effects comparable to those of oral or transdermal oestrogens.
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