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  • Title: The levonorgestrel intrauterine system in the management of menorrhagia.
    Author: Barrington JW, Bowen-Simpkins P.
    Journal: Br J Obstet Gynaecol; 1997 May; 104(5):614-6. PubMed ID: 9166207.
    Abstract:
    OBJECTIVE: To assess the effect of a levonorgestrel releasing intrauterine system in the management of menorrhagia. DESIGN: A prospective study. SETTING: A district general hospital in South Wales. METHODS: Fifty women with a failed trial of medical therapy and awaiting hysterectomy or transcervical resection of the endometrium (TCRE) were treated with a levonorgestrel intrauterine system. The menstrual loss was estimated using a modified pictorial chart together with a full blood count and ferritin measurement preinsertion and at three and six to nine months postinsertion. RESULTS: The menstrual loss was reduced to acceptable levels in 37 women at three months and a further four by six to nine months. In all, 41 patients were taken off the waiting list for surgery, four of whom became amenorrhoeic. There was no significant change in full blood count nor ferritin measurement despite unscheduled bleeding for six to eight weeks postinsertion. Fifty-six percent of patients noticed considerable improvement or cure of their premenstrual syndrome symptoms; 80% noted a reduction in dysmenorrhoea. CONCLUSION: The levonorgestrel releasing intrauterine system is an effective nonsurgical treatment for the management of menorrhagia and dysmenorrhoea that has additional benefit as a contraceptive and in relieving premenstrual syndrome. A prospective study involving 50 women recruited from a district general hospital in South Wales indicated that the levonorgestrel-releasing intrauterine system (LNG-IUS) represents an effective nonsurgical treatment for menorrhagia and dysmenorrhea. Treatment for menorrhagia with a combination of prostaglandin synthetase inhibitors and antifibrinolytic drugs had failed in these women, and they were on a waiting list for hysterectomy or transcervical resection of the endometrium. Menstrual loss was estimated using a modified pictorial chart and the full blood count and ferritin were measured preinsertion and at 3 and 6-9 months postinsertion. The device was spontaneously expelled in 6 women and almost all subjects experienced some unscheduled bleeding during the first 6-8 weeks postinsertion. Of the 42 women who attended the 3-month visit, 37 were satisfied with the results of the LNG-IUS device and wished to continue; only 5 had no significant reduction in their menstrual scores. Also observed was a reduction in clots and "flooding" and marked improvements in associated dysmenorrhea. 4 women became amenorrheic and 28 were cured of their premenstrual syndrome symptoms. There was no significant change in the full blood count or ferritin. At the 6-9 month visit, 4 of the 5 women who previously reported no change in menstrual scores now reported their menstrual loss was acceptable.
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