Use of a levonorgestrel-releasing intrauterine device for the symptomatic treatment of uterine myomas
Rosa e Silva, J.Cesar.; de Sá Rosa e Silva, A.Carolina.Japur.; Cândido dos Reis, F.Jose.; Manetta, Lís.Alberto.; Ferriani, R.Alberto.; Nogueira, Aônio.Alberto.
Journal of Reproductive Medicine 50(8): 613-617
2005
ISSN/ISBN: 0024-7758 PMID: 16220768 Document Number: 588025
OBJECTIVE: To assess the effect of a levonorgestrel-releasing intrauterine device -(LNG-IUD) for the treatment Of women with uterine myomas with increased bleeding by measuring total uterine volume and by determining patient clinical improvement, uterine artery flow velocity and hemoglobin levels.STUDY DESIGN: Ten patients with a complaint of increased uterine bleeding associated with the presence of uterine myomas were assessed in a descriptive case series and studied before and 6 months after placement of an LNG-IUD. The patients were assessed for intensity of bleeding, uterine volume, Doppler velocimetry of the uterine arteries, hematocrit and hemoglobin.RESULTS: One patient asked to be released from the study 15 days after LNG-IUD insertion, claiming the occurrence of increased bleeding, and 2 patients underwent spontaneous expulsion of the device after 2 and 4 months of follow-up. Of the 7 patients who continued the study, 3 started to present a bleeding pattern of the oligomenorrhea type, and the other 4 experienced amenorrhea. All patients (n = 6) with anemia at the beginning of the study presented normalization of hematocrit and hemoglobin levels after 6 months of treatment (p=0.0003 and p < 0.0001, respectively. However, we observed no reduction in uterine volume (p=0.11) or flow velocity-assessed by the uterine artery pulsatility index (right,p=0.17; left, p=0.19) and resistance index (right, p = 0.54; left, p = 0.31) using Doppler velocimetry.CONCLUSION: Use of an LNG-IUD may be effective in controlling uterine bleeding secondary to myomatosis even in the absence of reduction of uterine volume.