Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases

Kim, Miseon; Seong, Seok Ju

doi:10.5468/ogs.2013.56.2.67

Cited by 35 publications

(39 citation statements)

References 87 publications

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“…Progestin affects secretory differentiation of EM glands, inhibits cellular differentiation of EM and estrogen receptor functions, promotes apoptosis, and has antiangiogenic effects; thereby, inhibiting the proliferation of endometrium [14]. Combined treatment with high-dose oral progestin and LNG-IUS induces EM atrophy by inhibiting EM proliferation just as in postmenopausal women.…”

Section: Discussionmentioning

confidence: 99%

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Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

et al. 2017

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ObjectiveTo determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS).MethodsWe conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics.ResultsTwenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation.ConclusionTo evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.

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Section: Discussionmentioning

confidence: 99%

“…The importance of fertility sparing treatment is being emphasized in young EC patients. Typical drugs that can be used include systemic progesterone and levonorgestrel intrauterine system (LNG-IUS) [4567891011121314]. …”

Section: Introductionmentioning

confidence: 99%

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

et al. 2017

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“…reported no effect on fibroid volume but a decrease in uterine volume; however, Sangkomkamhang et al . and Kim and Seong reported no change in both uterine and fibroid volume. Zapata et al .…”

Section: Hormonal Treatmentsmentioning

confidence: 93%

“…Zapata et al . and Kim and Seong reported higher device expulsion rates that appear to increase with uterine volume. However, Jiang et al .…”

Section: Hormonal Treatmentsmentioning

confidence: 94%

“…The levonorgestrel intrauterine system (LNG‐IUS) has been widely accepted as an effective treatment of heavy menstrual bleeding. There is general agreement among several reviews that use of the LNG‐IUS in women with fibroids is successful in reducing menstrual blood loss, increasing haemoglobin and relieving symptoms . There are conflicting results regarding its effect on fibroid or uterine volume and device expulsion rates.…”

Section: Hormonal Treatmentsmentioning

confidence: 99%

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A review of evidence‐based management of uterine fibroids

Younas

Hadoura

Majoko

et al. 2016

The Obstetric & Gynaecologis

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Key content Fibroids are the most common uterine growth and there is an increasing range of options for their management. Management options are affected by the woman's symptoms, age, desire to conceive and local resources. Pharmacological agents are effective in alleviating symptoms and may improve women’s quality of life. Interventional radiology procedures may prevent the need for hysterectomy. Conventional surgical procedures and minimal access surgery are important in management of fibroids. Learning objectives To understand the options available for the management of uterine fibroids. To create awareness of radiological techniques, such as uterine artery embolisation and magnetic resonance imaging‐guided focused ultrasonography, that preserve the uterus. To understand the use of pharmacological agents in the reduction of menstrual blood loss and fibroid size. Ethical issues Is it ethical to offer new minimally invasive treatment options for fibroids to older women who wish to retain potential fertility?

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Fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer

Fernández-Montolí

Sabadell

Martínez-García

et al. 2018

Cochrane Database of Systematic Reviews

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Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases

Cited by 35 publications

References 87 publications

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

A review of evidence‐based management of uterine fibroids

Fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer

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