Abstract
Background
A prospective cohort study was carried out to evaluate uterine volume and the volume
of uterine leiomyomas in women using the levonorgestrel intrauterine system (LNG-IUS)
to treat idiopathic menorrhagia (n=32) and menorrhagia due to leiomyomas (n=27). A control group used the device as a contraceptive method (n=28).
Methods
Clinical and ultrasonographic evaluations were carried out at insertion and at 3,
6, 12, 24 and 36 months later. Total uterine volume and the volume of the leiomyomas
were calculated using the ellipsoid formula (anteroposterior diameter)��(transverse
diameter)��(longitudinal diameter)��(4/3)��(��). In the case of multiple leiomyomas,
the volume of each myoma was added to calculate the total volume of leiomyomas in
each patient. Menstrual bleeding episodes were recorded.
Results
Uterine volume decreased significantly in both groups of menorrhagic patients but
not in the control group. In the group of women with idiopathic menorrhagia, a mean
reduction of 36.4��15.3 (S.D.) cm3 (from 127.1 cm3 to 90.7 cm3) was observed (p=.041), and a greater and more significant mean reduction of 63.6��19.0
(S.D.) cm3 (from 156.6 cm3 to 93��cm3) occurred in the group of women with leiomyomas (p=.014). In the contraception group,
the reduction was of only 2.9��5.4 (S.D.) cm3 in mean uterine volume (from 70.3 cm3 to 67.4 cm3), which was not statistically significant (p=.085). The mean volume of leiomyomas
decreased by 5.2��3.1 (S.D.) cm3 (from 12.8 cm3 to 7.6 cm3) after 3 years of use, but this difference was not significant (p=.4099). After 36
months of use, amenorrhea and oligomenorrhea were the most frequent bleeding patterns,
occurring in 45���57% and 33���39% of users in the three groups, respectively. Amenorrhea
was higher in the contraception group (57.1%) and in women with idiopathic menorrhagia
(53.4%) than women in the group with menorrhagia due to leiomyomas (44.5%) (p=.027).
Moreover, the prevalence of spotting was almost three times higher (11%) in women
with menorrhagia caused by leiomyomas and nearly double (7.7%) in the idiopathic menorrhagia
group when compared with 4% in the control contraception group (p=.024).
Conclusion
The LNG-IUS significantly reduces uterine volume in women with menorrhagia with and
without leiomyoma; however, it does not significantly reduce the volume of leiomyomas.
Keywords
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Article info
Publication history
Published online: January 17, 2007
Accepted:
November 14,
2006
Received in revised form:
November 13,
2006
Received:
January 24,
2005
Footnotes
���This study received no funding, and each patient paid the costs of her own treatment.
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
