Evaluation of non-contraceptive benefits of LNG-IUS: A clinical study

Abstract

Introduction: IUCDs are the most widely used and effective contraceptive methods and are safe. Huge variety of IUCDs are available which include inert, copper containing, and medicated with levonorgestrel or indomethacin. LNG has been explored for its non-contraceptive benefits by various researchers and found to be effective for women and adolescents as first line therapy with heavy menstrual bleeding and is associated with improved dysmenorrhoea.so we did a two year perspective study in deptt of obs and gynae at GMC Patiala to assess the role of LNG-IUS IN various gynaecological indication otherthan contraception. Material and Methods: Women with heavy menstrual period, dysmenorrhea or both who reported in the OPD were examined, including breast and pelvic examination. USG was done to note various pathologies like fibroid, endometriosis, endometrial hyperplasia, adenomyosis and functional ovarian cyst. This was followed by endometrial biopsy. After the biopsy report was available, decision for LNG-IUS insertion was taken. LNG-IUS was inserted, under all sterile conditions without anaesthesia. After insertion, patient was followed up at 1-, 3-, 6-and 12-month interval for menstrual pattern change any complications compliance on part of patient. Results: A total of 30 patients were enrolled over a period of two years. 28 patients were in the age group 30-50 years and only 2 patients were post-menopausal. 56.6% had rural background, 43% were illiterate and 83.3% were multipara. In 50% of the women, the chief complaint was heavy menstrual bleeding with dysmenorrhea and 36% had heavy menstrual bleeding alone. 6.6% had dysmenorrhea alone and another 10% reported with irregular bleeding. According to PALM-COIEN classification, AUB-A was diagnosed in 16.6%, AUB-L in 30%, AUB-O in 40%, AUB-M in 3.3%, endometriosis in 13.3%. LNG-IUS was not used as contraception or HRT in any of the cases. On post insertion follow up after one month, 90 percent had relief from heavy menstrual bleeding. At sixmonth follow-up, 23.3% reported spotting and 60% reported normal flow during periods. After one year 73.9% patient had normal flow and 13% patients achieved amenorrhoea. The irregular bleeding or spotting was managed by giving supportive therapy in form of reassurance in 30%, NSAIDS in 16.6%, and norethisterone in 46.6%. Ormeloxifene and OCPs were given in 3.3% each and response was satisfactory. At one year follow up it was seen that 76.6% patients continued with LNG IUS and found it comfortable with enhanced quality of life. Conclusion: LNG-IUS is a better choice for the management of endometrial hyperplasia simple or complex, with or without atypia, AUB, adenomyosis and endometriosis. LNG-IUS can be a good alternative to hysterectomy.