The levonorgestrel-releasing intrauterine system: its effect on the number of hysterectomies performed in perimenopausal women with uterine fibroids

Abstract

This prospective observational study was designed to determine the percentage of hysterectomies avoided following insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) in perimenopausal women with uterine fibroids and a prior indication for surgery. The study also compared the progress of patients using the LNG-IUS with those submitted to hysterectomy, with particular emphasis on the patient's satisfaction with treatment. Sixty perimenopausal patients with uterine fibroids and excessive bleeding referred for hysterectomy were included. After counseling on the possibility of non-surgical treatment, 39 patients opted to use an LNG-IUS while 21 opted for hysterectomy. Continuation of LNG-IUS use and the patient's satisfaction with the chosen procedure were assessed. A secondary analysis evaluated hemoglobin levels, clinical complications, bleeding patterns and uterine volume at ultrasonography over time. After 24 months of follow-up, four of the patients who had opted to use an LNG-IUS were submitted to surgery, while 35 continued using the device, thus avoiding hysterectomy in 89.5% of cases. LNG-IUS users were more satisfied with treatment (p = 0.02) compared to those submitted to hysterectomy. In conclusion, the use of the LNG-IUS enables the number of hysterectomies to be reduced in women with uterine fibroids and is associated with greater satisfaction compared to surgical treatment.

Fibroid growth and medical options for treatment

“…The levonorgestrelreleasing IUS (LNG-IUS) has been approved by the United States Food and Drug Administration to treat heavy menstrual bleeding in IUS users. In women with fibroid-related uterine bleeding, the LNG-IUS has been shown to reduce bleeding and improve anemia (88,93). However, tumor volume was not reduced.…”

“…In addition, insertion of an IUS can be difficult in women with submucosal fibroids, and the device can be expelled more frequently (94). However, the use of LNG-IUS may reduce the rate of hysterectomy and improve patient satisfaction (93).…”

Role of levonorgestrel releasing intra-uterine system in the treatment of menorrhagia due to dysfunctional uterine bleeding and fibroid uterus

“…In a recent study by Machado et al, not only did the treatment with LNG-IUS help avoid hysterectomy in 89.5% of cases, but also, the patients treated with LNG-IUS were more satisfied compared to those primarily undergoing hysterectomy. 9 While hysteroscopic myomectomy is a good option for submucosal fibroids, the surgical risks of myomectomy become more relevant in non-submucosal fibroids, and such cases presenting with menorrhagia can be better dealt with LNG-IUS. Thermal ballon ablation is another option for such patients, which has been shown to have similar success rates (76%) as with LNG-IUS (79%).…”

“…In recent years LNG-IUS has been increasingly advocated as an alternative to hysterectomy for menorrhagia. [6][7][8][9][10] This intrauterine system consists of a T-shaped polyethylene frame (32 mm × 32 mm) with a levonorgestrel (LNG)-containing reservoir around its vertical stem. It contains a 1:1 mixture of 52 mg of LNG and polydimethylsiloxane as the carrier polymer.…”

The role of levonorgestrel intrauterine systems in the treatment of symptomatic fibroids

“…evaluated the percentage of hysterectomies avoided following the insertion of LNG-IUS in perimenopausal women with uterine fibroids and a prior indication for surgery. Within 24 months of follow-up 89.5% of patients using LNG-IUS avoided hysterectomy and were more satisfied with treatment ( p = 0.02) compared to those treated surgically [ 24 ]. Kaunitz et al .…”