Noncontraceptive Benefits of The Levonorgestrel-releasing Intrauterine Device
Abstract & Commentary
By Alison Edelman, MD, MPH, Assistant Professor, Assistant Director of the Family Planning Fellowship Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, is Associate Editor for OB/GYN Clinical Alert.
Dr. Edelman reports no financial relationship to this field of study
Synopsis: The levonorgestrel-releasing intrauterine device improved symptoms for women with ultrasound-proven adenomyosis.
Source: Cho S, et al. Am J Obstet Gynecol. 2008;198:373.e1-373.e7.
Cho and colleagues studied 47 women with ultrasound-proven adenomyosis over a 3-year time period. They measured uterine volume, Doppler blood flow, menstrual blood loss (pictorial blood loss assessment chart), and dysmenorrhea (10 cm visual analog scale) before and after placement of the levonorgestrel-releasing intrauterine device. Three out of the 47 women did not finish the study (2 experienced expulsions and 1 was removed due to irregular bleeding). Thirty-two women completed the entire 3 years of follow-up (68%). All outcome measures significantly improved over the course of the study. By 6 months, women reported a significant improvement in adenomyosis-related symptoms [dysmenorrhea-related pain before: 8.55 cm, after: 1.93 cm (p < 0.05) and menstrual blood loss before: 201.43, after 10.95 (p < 0.05).
Commentary
The levonorgestrel-releasing intrauterine device (Mirena®, Bayer Health Care Pharmaceuticals) has proven to be not only a highly effective contraceptive method but also continues to expand its noncontraceptive benefits (off-label use). Although relatively small, there have now been several studies which have shown a marked benefit of the levonorgestrel-releasing intrauterine device on adenomyosis-related symptoms.1-3 A head-to-head trial of hysterectomy, the standard treatment option for adenomyosis, compared to the levonorgestrel-releasing intrauterine device has not been published but one can assume that an IUD is a safer and more cost-effective alternative. In addition, many women may prefer an IUD over major surgery or may have medical problems in which avoiding the operating room may be safer for both the physician and the patient.
Obviously the levonorgestrel-releasing intrauterine device will not be a panacea for all women with adenomyosis. Bleeding expectations are an important issue to discuss. We know that women using the levonorgestrel-releasing intrauterine device for contraception only can experience irregular bleeding patterns but many achieve amenorrhea with greater duration of use. In comparison, women with adenomyosis may have lower rates of amenorrhea and higher rates of spotting but an overall impressive decrease in the amount of menstrual-associated blood loss. This bleeding pattern appeared tolerable to study participants but it's an important distinction between adenomyosis treatment with an IUD vs a hysterectomy.
References
- Cho S, et al. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. Am J Obstet Gynecol. 2008;198:373.e1-373.e7.
- Bragheto A, et al. Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception. 2007;76:195-199.
- Fedele L, et al. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68:426-429.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content