LEVONORGESTREL INTRAUTERINE DEVICE VERSUS MEDROXYPROGESTERONE ACETATE IN TREATMENT OF SYMPTOMATIC UTERINE FIBROIDS
Keywords:Leiomyoma, Levonorgestrel Intrauterine Device, Medroxyprogesterone Acetate, Menorrhagia, Pelvic Pain, Uterus
Background: Medroxyprogesterone acetate (MPA) and levonorgestrel intrauterine device (LNG-IUD) are two drugs used to treat abnormal uterine bleeding in women with myoma. We organized this study to compare the effectiveness of these two treatments.
Methods: This was a retrospective one-year-long cohort study of 95 women with uterine leimyoma. Fifty three women who had received LNG-IUD formed the LNG-IUD group while 42 women who received regular intramuscular injections of 150 mg MPA at every 3 months for one-year period made up the MPA group. Both groups were compared in aspect of demographic, clinical and biochemical characteristics.
Results: At the end of one year, the LNG-IUD group had significantly smaller fibroid size, lower visual analogus scale score for pelvic pain, for dysmenorrhea and dyspareunia than the MPA group. There were a significant reduction in the number of patients with menorrhagia and a significant increase in serum hemoglobine levels both in LNG-IUD and MPA groups at the end of the one-year long study period.
Conclusions: LNG-IUD appears as a good choice for the reduction in fibroid size and associated pelvic pain.
Soliman AM, Yang H, Du EX et al.: “The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013ˮ. Am J Obstet Gynecol. 2015, 213, 141.
Stewart EA.: “Clinical practice. Uterin Fibroidsˮ. N Engl J Med. 2015, 372, 1646. DOI: https://doi.org/10.1056/NEJMcp1411029
Khan AT, Shehmar M, Gupta JK.: “Uterine fibroids: current perspectivesˮ. Int J Womens Health,. 2014, 6, 95.
Doherty L, Mutlu L, Sinclair D et al.: “Uterine fibroids: clinical manifestations and contemporary managementˮ. Reprod Sci., 2014, 21, 1067.
Owen C, Armstrong AY.: “Clinical management of leiomyomaˮ. Obstet Gynecol Clin North Am., 2015, 42, 67. DOI: https://doi.org/10.1016/j.ogc.2014.09.009
Singh SS, Belland L.: “Contemporary management of uterine fibroids: focus on emerging medical treatmentsˮ. Curr Med Res Opin., 2015, 31, 1. DOI: https://doi.org/10.1185/03007995.2014.982246
Moroni R, Vieira C, Ferriani R et al.: “Pharmacological treatment of uterine fibroidsˮ. Ann Med Health Sci Res., 2014, 4, 185. DOI: https://doi.org/10.4103/2141-9248.141955
Wu JP, Pickle S.: “Extended use of the intrauterine device: a literature review and recommendations for clinical practiceˮ. Contraception., 2014, 89, 495. DOI: https://doi.org/10.1016/j.contraception.2014.02.011
Sangkomkamhang US, Lumbiganon P, Laopaiboon M et al.: “Progestogens or progestogen-releasing intrauterine systems for uterine fibroidsˮ. Cochrane Database Syst Rev., 2013, 28, 2:CD008994. DOI: https://doi.org/10.1002/14651858.CD008994.pub2
Jacobstein R, Polis CB.: “Progestin-only contraception: injectables and implantsˮ. Best Pract Res Clin Obstet Gynaecol., 2014, 28, 795. DOI: https://doi.org/10.1016/j.bpobgyn.2014.05.003
Nelson AL.: “Levonorgestrel intrauterine system: a first-line medical treat¬ment for heavy menstrual bleedingˮ. Womens Health (Lond Engl)., 2010, 6, 347. DOI: https://doi.org/10.2217/WHE.10.16
Amanti L, Sadeghi-Bazargani H, Abdollahi H et al.: “Uterine leiomyoma and its association with menstrual pattern and history of depo-medroxyprogesterone acetate injectionsˮ. Int J Gen Med., 2011, 4, 535. DOI: https://doi.org/10.2147/IJGM.S23337
Wildemeersch D, Schacht E.: “The effect on menstrual blood loss in women with uterine fibroids of a novel “frameless” intrauterine levonorgestrel- releasing drug delivery system: a pilot studyˮ. Eur J Obstet Gynecol Reprod Bio.,. 2002, 102, 74.
Gunes M, Ozdegirmenci O, Kayikcioglu F et al.: “The effect of levonorgestrel intrauterine system on uterine myomas: A one-year follow-up studyˮ. J Minim Invasive Gynecol., 2008, 15, 735. DOI: https://doi.org/10.1016/j.jmig.2008.08.011
Kaunitz AM, Meredith S, Inki P et al.: “Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: A systematic review and meta-analysis. Obstet Gynecol., 2009;113:1104-1116.
Monteiro I, Bahamondes L, Diaz J et al.: “Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: A pilot study (1) ˮ. Contraception., 2002, 65, 325. DOI: https://doi.org/10.1016/S0010-7824(02)00283-4
Magalhaes J, Aldrighi JM, Lima GR.: “Uterine volume and menstrual patterns in users of the levonorgestrel releasing intrauterine device with idiopathic menorrhagia or menorrhagia due to leiomyomasˮ. Contraception., 2007, 75, 193. DOI: https://doi.org/10.1016/j.contraception.2006.11.004
Ware RS, Inki P.: “The levonorgestrel intrauterine system. Long-term contraception and therapeutic effectsˮ. Future Med., 2005, 1, 171. DOI: https://doi.org/10.2217/17455057.1.2.171
Middleton LJ, Champaneria R, Daniels JP et al.: “Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patientsˮ. BMJ., 2010, 16, 341. DOI: https://doi.org/10.1136/bmj.c3929
Lee BS, Ling X, Asif S et al.: Levonorgestrel-releasing intrauterine system versus conventional medical therapy for heavy menstrual bleeding in the Asia-Pacific regionˮ. Int J Gynaecol Obstet., 2013, 121, 24. DOI: https://doi.org/10.1016/j.ijgo.2012.10.028
Grigorieva V, Chen-Mok M, Tarasova M et al.:Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomasˮ. Fertil Steril.,. 2003, 79, 1194.
Venkatachalam S, Bagratee JS, Moodley J: Medical management of uterine fibroids with medroxyprogesterone acetate (Depo Provera): a pilot studyˮ. Obstet Gynecol., 2004, 24, 798. DOI: https://doi.org/10.1080/01443610400009543
Harmon QE, Baird DD: Use of depot medroxyprogesterone acetate and prevalent leiomyoma in young African American womenˮ. Hum Reprod., 2015, 30, 1499.
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