Long-term efficacy and feasibility of levonorgestrel-releasing intrauterine device use in patients with adenomyosis

Abstract

To evaluate the efficacy and feasibility of levonorgestrel-releasing intrauterine device (LNG-IUD) use longer than 5 years in women with adenomyosis. Data were retrospectively collected from patients who were treated with LNG-IUD longer than 5 years at the Chungnam National University hospital for adenomyosis diagnosed with ultrasonography from January 2006 to November 2013. A total of 131 patients who were diagnosed with adenomyosis had treated with LNG-IUD longer than 5 years. The mean duration of keeping 1 device without replacement was 58.35 ± 15.98 months, and total duration of LNG-IUD treatment was 83.86 ± 23.88 months. A total of 51 patients stopped using LNG-IUD after 5 years and the mean age at the time of LNG-IUD removal was 52.46 ± 6.9. LNG-IUD treatment had a significant effect on both menorrhagia and dysmenorrhea starting from the first month of insertion (P < .01), which persisted until 6 years when the effect started to plateau. The decrease in uterine volume was not consistent during the treatment period. The uterine volume decreased significantly only in the first and second year of LNG-IUD treatment and then from eighth to tenth year of LNG-IUD treatment (P < .05). Adverse events after insertion of LNG-IUD decreased significantly after 5 years. LNG-IUD treatment longer than 5 years is an effective and feasible method for patients diagnosed with adenomyosis.

Long-term efficacy and safety of levonorgestrel-releasing intrauterine system as a maintenance treatment for endometriosis

“…Localized side effects such as irregular uterine bleeding, vaginal bleeding, and vaginal discharge occurred more frequently in the LNG-IUS group. However, the incidence of all these symptoms significantly decreased after 5 years, consistent with another cohort study in which the incidence of adverse events decreased after 5 years in patients using LNG-IUS for endometriosis [22] . In the present study, systemic side effects such as mood changes, nausea, hair loss, acne, headache, and decreased bone density did not occur in the LNG-IUS group.…”

“…However, the incidence of all these symptoms significantly decreased after 5 years, consistent with another cohort study in which the incidence of adverse events decreased after 5 years in patients using LNG-IUS for endometriosis. [22] In the present study, systemic side effects such as mood changes, nausea, hair loss, acne, headache, and decreased bone density did not occur in the LNG-IUS group. In our study, patients in LNG-IUS group were older than patients in EE/DRSP or dienogest group.…”

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

“…Even if contraception remains their main purpose, IUDs are also used for several non-contraceptive issues [ 2 ], especially with the advent of the levonorgestrel-releasing intrauterine system (LNG-IUS) device, which is considered a great treatment option for women with abnormal uterine bleeding and heavy menstrual bleeding, as well as dysmenorrhea [ 2 , 3 ]. Similarly, LNG-IUS are used for the conservative treatment of atypical endometrial hyperplasia and early endometrial cancer following hysteroscopic resection in reproductive age women [ 4 ] as well as the treatment of adenomyosis and endometriosis [ 2 ]. LNG-based IUDs are commonly used by women desiring to use local hormonal contraception [ 5 ].…”

Conservative Management of Uterine Adenomyosis: Medical vs. Surgical Approach

“…The LNG-IUD, an intrauterine version of progestin, has also been proposed to manage symptomatic adenomyosis, yielding satisfactory outcomes, but with some debate around appropriate treatment durations [ 11 , 25 , 26 , 27 , 28 , 29 , 30 ]. One clinical trial involving 47 patients reported pain relief from the sixth week after insertion, and a significant decrease in mean uterine volume by month 12 [ 28 ].…”

“…On the contrary, another trial demonstrated more long-term effects of the LNG-IUD against adenomyosis symptoms, as both dysmenorrhea and uterine volume remained significantly reduced after 3 years of follow-up of 94 enrolled patients [ 29 ]. A more recent retrospective study suggested that the beneficial impact of LNG-IUDs on heavy bleeding and dysmenorrhea, but not uterine volume reduction, may last up to six years post-insertion [ 30 ].…”