Combined endometrial ablation and levonorgestrel intrauterine system use in dysmenorrhea and heavy menstrual bleeding

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Combined endometrial ablation and levonorgestrel intrauterine system use in dysmenorrhea and heavy menstrual bleeding
Key Take-Away: 

Painful menstruation with heavy bleeding is the common problem for most of the women. A novel treatment approach which includes drug with latest technology is the need of the hour and this is what this study shows!

To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years.

ABSTRACT: 
Background: 

To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding

To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years.

Methods: 

This is a Cohort study which took place in an academic institution in the upper Midwest. All women with HMB and dysmenorrhea who underwent EA with combined placement of LNG-IUS (EA/LNG-IUS cohort, 23 women) after 2005

and an historic reference group from women who had EA alone (EA cohort, 65 women) from 1998 through the end of 2005 were included in the study and were given Radiofrequency EA, thermal balloon ablation, and LNG-IUS.

Results: 

The primary outcome was treatment failure defined as persistent pain, bleeding, and hysterectomy after EA at 4 years. The combined treatment failure outcome was documented in 2 patients (8.7%) in the EA/LNG-IUS group and 19 patients (29.2%) in the EA group with an unadjusted OR of .23 (95% CI, .05–1.08).

After adjusting for known risk factors of failure, the adjusted OR was .19 (95% CI, .26–.88). None of the women who underwent EA/LNG-IUS had hysterectomy for treatment failure compared with 16 (24%) in the EA group (p = .009); postablation pelvic pain was documented in 1 woman (4.3%) in the EA/LNG-IUS group compared with 8 women (12.3%) in the EA group (p = .24). One woman in the EA/LNG-IUS group (4.3%) presented with persistent bleeding compared with 15 (23.1%) in the EA group (p = .059). Office removal of the intrauterine device was performed in 4 women with no complications.

Conclusion: 

LNG-IUS insertion at the time of EA is feasible and can provide added benefit after EA in women with dysmenorrhea and HMB.

Journal of Minimally Invasive Gynecology. 2015 June 26
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