The Use of Levonorgestrel-Releasing System (Metraplant-E) in the Treatment of Abnormal Uterine Bleeding

Abstract

Background: Dysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. Objective: The aim of this work is to evaluate the effect of this new form of levonorgestrel-releasing IUD on the treatment of patients with abnormal uterine bleeding. Subjects and methods: A prospective age-specific comparative analysis of 61 peri-menopausal women presented with dysfunctional uterine bleeding who constituted the study group. They underwent hysteroscopy and endometrial sampling during an 18 months period from June 2014 to January 2016 at Ain Shams University Materity Hospital. Prior to metraplant-E application, all the patients in this study were in the age of 25-58 years old. Results: The role of Metraplant-E in the treatment of abnormal uterine bleeding (AUB) was evaluated. Sixty-one women with failed attempt(s) of medical treatment unwilling or unfit for hysterectomy were treated with Metaplant-E. Menstrual blood loss was assessed by pictoral bleeding assessment chart (PBAC), bleeding index (B.I) and total bleeding score (T.B.S/month). The bleeding patterns in the form of the mean menstrual blood loss estimated by bleeding index and the mean menstrual loss estimated by the total bleeding score/month and PBAC decreased significantly (p = 0.001). The quality of life scale (Likert scale) improved significantly (p = 0.001). All 15 cases who had endometrial sampling demonstrated progestational effect on histo-pathological examination. Conclusion: Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical and histopathological levels. Keywords: Metraplant-E, LNG-IUS, Menorrhagia, Contraceptives INTRODUCTIONDysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. The peri-menopausal women who have anovulatory cycle resulting in DUB. The normal menstrual cycle is defined as having a mean interval of 28 ± 7 days with a men duration of 4 ± 3 days. The upper limit of normal menstruation is 80 ml per menstruation. Any deviation from the normal cycle and the amount of loss is regarded as abnormal uterine bleeding. Dysfunctional uterine bleeding (DUB) is one of the commonest causes of abnormal uterine bleeding. It is defined as heavy and/or irregular menstruation in the absence of detectable pelvic pathology, pregnancy or general bleeding disorder. It affects 20 to 30 % of women and accounts for 12 % of gynecological referrals. DUB can be ovulatory or anovulatory. Anovulatory DUB occurs at extreme reproductive age (adolescence and peri-menopausal age)