Endometrial morphology during long-term use of levonorgestrel-releasing intrauterine devices

Levonorgestrel-releasing intrauterine devices (IUD) were inserted in 92 women. Endometrial biopsies were taken between 3 months and 7 years after these insertions. Intrauterine release of levonorgestrel resulted in endometrial glandular atrophy and decidualized stroma. Inflammation and necrosis were also seen as local signs of IUD use. The biopsies were similar regardless of the duration of IUD use. Endometrial morphology returned to normal in biopsy specimens taken 1-3 months after IUD removal.     

Two years' experience with two levonorgestrel-releasing intrauterine devices and one copper-releasing intrauterine device: a randomized comparative performance study

A randomized comparative performance study of two levonorgestrel intrauterine devices (IUDs) and a copper (Nova-T) IUD (Leiras, Turku, Finland) was performed at two clinics in Finland and one in Brazil. The 24-month cumulative event rates per 100 women are reported. Six thousand woman-months of use were recorded with the levonorgestrel IUD and 3000 with the Nova-T device. Pregnancy rates at 2 years of use were 0.6 and 0 with the two levonorgestrel IUDs and 3.3 with the Nova-T IUD. Removal rates because of bleeding and/or pain were low with all three IUDs: 7.5, 7.6, and 7.1, respectively, at 24 months. Recordings of the number of days of bleeding showed significantly fewer days of bleeding during use of the levonorgestrel IUDs than the Nova-T IUD from the second month of use onward, until the end of the second year. No infections were recorded in association with use of the levonorgestrel IUDs, and only one termination because of infection was recorded for the Nova-T IUD. The continuation rates of use at 24 months were 66.6, 60.7, and 71.9 for the two levonorgestrel IUDs and the Nova-T IUD, respectively; the differences were not statistically significant.     

Sexual functioning in women using levonorgestrel-releasing intrauterine systems as compared to copper intrauterine devices

IntroductionThere has been little research published on the impact of intrauterine contraceptive (IUC) methods on sexual functioning.AimsThis study aimed: (i) to assess different aspects of sexual functioning, including the prevalence of sexual dysfunction in women using a levonorgestrel intrauterine system (LNG‐IUS); (ii) to compare this prevalence with that among copper‐releasing intrauterine device (Cu‐IUD) users; and (iii) to identify the relationship between psychological variables and sexual functioning in women using one of the aforementioned IUCs.MethodsIn a multicenter cross‐sectional study, 845 women with an IUC were invited to fill out a questionnaire. The latter was returned by 402 (48%) of them: 353 women were LNG‐IUS users (88%) and 49 were Cu‐IUD users (12%). The questions asked pertained to depression, well‐being, marital relation quality, and sexual functioning.Main Outcome MeasuresSexual functioning was measured with the Short Sexual Functioning Scale.ResultsOne‐third of LNG‐IUS users (33%) reported a sexual dysfunction. Of those, 20% reported an increased sexual desire, 25% a decreased sexual desire, 5% arousal problems, and 8% orgasm problems. Women using a LNG‐IUS did not differ significantly in distribution, type, or prevalence (32.9% vs. 36.7%) of sexual dysfunction, nor in depressive symptoms (Beck Depression Inventory score; 4.7 vs. 3.9; P = 0.33), general well‐being (WHO‐5 well‐being scale score; 16.8 vs. 17.7; P = 0.170), or partner relationship quality (Dyadic Adjustment Scale score; 107 vs. 108; P = 0.74) compared to Cu‐IUD users. Overall, the perceived influence of IUCs on sexual functioning was in the lower range and did not differentiate LNG‐IUS greatly from Cu‐IUD‐users.ConclusionWomen using a LNG‐IUS do not differ from those wearing a Cu‐IUD with regard to psychological and sexual functioning. The perceived impact of IUD use on sexuality should not be overestimated. Enzlin P, Weyers S, Janssens D, Poppe W, Eelen C, Pazmany E, Elaut E, and Amy J‐J. Sexual functioning in women using levonorgestrel‐releasing intrauterine systems as compared to copper intrauterine devices. J Sex Med 12;9:1065–1073.     

The levonorgestrel-releasing intrauterine system and endometriosis staging

This study aims to determine whether the levonorgestrel-releasing intrauterine system can influence American Society for Reproductive Medicine endometriosis staging scores, as assessed through second-look laparoscopies, and to compare the results with those obtained with a GnRH agonist. Both treatments reduced the extent of pelvic endometriotic lesions in patients with chronic pelvic pain.     

Use of the levonorgestrel-releasing intrauterine system and breast cancer

OBJECTIVE: The effect of exogenous hormones on the incidence of breast cancer has been extensively studied. Most studies regarding hormonal contraception have focused on combined oral contraceptives, and there is paucity of literature regarding nonoral and progestin-only contraceptives. The present study analyzed the relationship between breast cancer and use of the levonorgestrel-releasing intrauterine system. METHODS: This study was based on data gathered from a large postmarketing study on levonorgestrel-releasing intrauterine system users (n = 17,360) carried out in Finland. The results present an incidence comparison between levonorgestrel system user data and the data on average Finnish female population (derived from the Finnish Cancer Registry), between 30 and 54 years of age. RESULTS: Based on the 95% confidence intervals for the incidences of breast cancer, and the Fisher exact test, there is no indication of a difference between the levonorgestrel system users and average Finnish female population in any of the 5-year age groups. The incidence rate per 100,000 woman-years was for the age groups 30-34 years 27.2 and 25.5, for 35-39 years 74.0 and 49.2, for 40-44 years 120.3 and 122.4, for 45-49 years 203.6 and 232.5, and for 50-54 years 258.5 and 272.6, in the levonorgestrel system group and in Finnish female population, respectively. CONCLUSION: The results suggest that the use of the levonorgestrel-releasing intrauterine system is not associated with an increased risk of breast cancer.     

Use of three-dimensional ultrasound in evaluating the intrauterine position of a levonorgestrel-releasing intrauterine system

This paper reports the first case of three-dimensional (3-D) transvaginal ultrasonography (TVS) imaging of malpositioned levonorgestrel-releasing intrauterine system (LNG-IUS). In patients carrying LNG-IUS, the application of 3-D TVS with the adjunctive volume contrast imaging in the coronal plane (VCI-C) and inversion rendering modes clearly display the correct spatial position of the LNG-IUS in relation to the uterine cavity much better than two-dimensional ultrasound.     

Efficacy of the levonorgestrel-releasing intrauterine system in uterine leiomyoma

ObjectiveTo evaluate the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in reducing menstrual blood loss (MBL) in myoma-related menorrhagia and to assess the effect of the LNG-IUS on uterine and leiomyoma volume.MethodsA prospective comparative study investigated the effect of LNG-IUS use in women with myoma-related menorrhagia (n = 54) and women with idiopathic menorrhagia (n = 50). The outcome was assessed in terms of reductions in MBL and in myoma and uterine volume.ResultsWithin 1 month of LNG-IUS insertion, the Pictorial Blood Loss Assessment Chart score in the myoma group fell by 86.8% (P < 0.0001). At 3, 12, 24, 36, and 48 months, the MBL was reduced by 92.1%, 97.4%, 97.4%, 99.5%, and 99.5%, respectively, similar to the effect seen in the idiopathic menorrhagia group. The mean uterine volume was significantly reduced in both groups, but the reduction was greater in the group with leiomyomas (idiopathic menorrhagia, P = 0.038; myoma-related menorrhagia, P = 0.012). There was no statistically significant reduction in the myoma volume (P = 0.409).ConclusionUse of the LNG-IUS appears to lead to a significant reduction in the uterine volume of women with menorrhagia, as well as reducing the MBL in women with uterine leiomyomas.     

花式280与宫铜300宫内节育器临床效果比较

目的探讨花式280与宫铜300两种宫内节育器(IUD)规范应用1年的临床效果、可行性和可接受性。方法采用前瞻性研究方法,自2007年7月1日至2008年12月30日,在甘肃农村已婚育龄妇女中随机放置花式280与宫铜300各1070例,共2140例,1年末的随访率为100.00%。结果使用满12个月时,花式280和宫铜300的累积续用率分别为97.57/100妇女和97.66/100妇女,累计妊娠率分别为0.19/100妇女和0.47/100妇女,累计脱落和下移率分别为1.51/100妇女和1.69/100妇女,累计终止率分别为2.43/100妇女和2.34/100妇女,累计因症终止率分别为0.65/100妇女和0.37/100妇女。最常见的副反应为出血和疼痛。结论规范应用花式280与宫铜300可有效提高避孕方法的使用效果,两种IUD避孕效果好,值得进一步推广应用。     

Endometrioid adenocarcinoma after insertion of a levonorgestrel-releasing intrauterine system

The levonorgestrel-releasing intrauterine system (IUS) is now widely used and recommended as a reliable contraceptive and treatment for menorrhagia. It also potentially provides a simple alternative to treatment for women with stage-1, grade-1 endometrial cancers who are at high risk for surgery. This case describes a 39-year-old multiparous patient who visited the gynecology outpatient department at a district general hospital with a history of heavy, prolonged periods for 1 year. Hysteroscopy and biopsy specimen revealed benign nonsecretory endometrium and a levonorgestrel-releasing IUS was inserted. The patient visited again 4 years later with an 8-month history of prolonged bleeding. Endometrial biopsy specimen confirmed well-differentiated endometrioid adenocarcinoma. This is the first case report, to our knowledge, where hysteroscopy was performed before levonorgestrel-releasing IUS insertion with conclusive evidence of initial negative malignancy followed by development of endometrial cancer 4 years after insertion. This case raises the question of the safety of levonorgestrel-releasing IUS for the prevention and treatment of endometrial hyperplasia and carcinoma.     

Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system

Objective

To estimate the incidence of, and identify risk factors for, spontaneous expulsion of the levonorgestrel-releasing intrauterine system (LNG-IUS).

Methods

Pre-insertion characteristics for 481 women who received the LNG-IUS at a single institution in the Republic of Korea between 2003 and 2011 were analyzed retrospectively. The median duration of follow-up was 13.4 months. Kaplan–Meier plots were constructed to estimate the time to occurrence of spontaneous expulsion in multiple subgroups.

Results

The overall crude incidence of spontaneous LNG-IUS expulsion was 9.6%. The cumulative incidence was 7.9%, 9.1%, and 9.6% at 1, 2, and 3 years, respectively. It was significantly higher in women with adenomyosis (9.1%, 10.6%, and 11.1%) or uterine leiomyoma (14.5%, 15.8%, and 15.8%) than in those with a normal uterus (3.6%, 4.1%, and 4.6%) (P = 0.008). Women with heavy menstrual bleeding (11.0%, 12.7%, and 13.4%), dysmenorrhea (8.1%, 9.0%, and 10.0%), or pre-insertion receipt of gonadotropin-releasing hormone agonists (13.3%, 16.0%, and 17.3%) also had higher cumulative incidences than those without these conditions (P < 0.05). Most (84.5%) women with a spontaneous expulsion chose to discontinue the device.

Conclusion

Clinicians need to be aware of the risk factors for spontaneous LNG-IUS expulsion because this can lead to a discontinuation of its use.     

左炔诺孕酮宫内缓释系统治疗子宫内膜增生的疗效及安全性

目的:观察左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫内膜增生的疗效及安全性。方法:151例子宫内膜增生症患者(排除子宫内膜癌)用曼月乐治疗,放置前和放置24个月内定期随访患者月经模式及血红蛋白水平;B超监测子宫内膜厚度、卵巢体积、子宫体积变化;子宫内膜病理学改变及卵巢激素水平变化。结果:放置后患者月经量明显减少,血红蛋白值明显升高,放置前血红蛋白水平为98.81±12.22g/L,放置后3,6,12,24个月血红蛋白值分别为116.53±9.62g/L,123.45±7.83g/L,127.26±8.02g/L,129.83±8.34g/L,各组间放置前后差异均有统计学意义(P<0.001);放置前子宫内膜厚度1.52±0.33cm,放置后3,6,12,24个月子宫内膜厚度分别为0.64±0.21cm,0.62±0.14cm,0.56±0.11cm,0.53±0.14cm,各组间放置前后差异均有统计学意义(P<0.001);放置曼月乐后6～12个月,患者子宫内膜病理显示子宫内膜增生过长表现消失,内膜呈分泌现象及间质蜕膜样改变明显;放置前后患者子宫、双侧卵巢体积及雌孕激素水平均无明显变化。结论:放置曼月乐可抑制子宫内膜增长及逆转增生的子宫内膜,副作用少,是治疗子宫内膜增生症安全、有效的方法,值得临床推广。     

左炔诺孕酮宫内缓释系统与子宫内膜异位症防治

左炔诺孕酮宫内缓释系统(LNG-IUS)作为一种防治子宫内膜异位症(EMs)的治疗方法,可有效缓解EMs患者痛经、深部性交痛及慢性盆腔痛,缩小盆腔及直肠阴道隔内膜异位病灶,降低保守性手术后中/重度痛经复发率.相关基础研究显示,LNG-IUS可促进在位内膜细胞凋亡,可能抑制在位内膜中环氧合酶2(COX-2)的表达和正常T细胞表达及分泌的激活调节细胞因子(RANTES)的产生、诱导1718-羟脱氢酶2(17-βHSD2)的表达,但对子宫内膜血管内皮生长因子(VEGF)水平可能无显著影响,LNG-IUS对在位内膜细胞表达基质金属蛋白酶类(MMPs)的影响尚不确定.     

Painful pelvic joints induced by a levonorgestrel-releasing intrauterine system

The normally occurring loosening of the pelvic joints with separation of the symphysis during pregnancy may give rise to pain over the symphysis pubis or/and over the sacroiliac joints. In contrast, increased mobility between the pubic bones and pelvic pain without any direct connection with pregnancy is rare and its etiology is unclear. The following is a report of a patient who experienced symphysiolysis-like pelvic pain following the use of a levonorgestrel-releasing intrauterine system.