Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı

Ünlü, Mehmet Cihat; TAŞKIN, Salih; ÖZMEN, Batuhan

Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı

Salih TAŞKIN, (Ankara Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

Batuhan ÖZMEN, (Ankara Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

Cihat ÜNLÜ (Ankara Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

Journal of the Turkish-German Gynecological Association

9 0

Yıl: 2006 Cilt: 7 Sayı: 1 Sayfa Aralığı: 63 - 67 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı

Öz:

Levonorgestrel salan intrauterin sistem, kontraseptif bir yöntem olarak geliştirilmiştir. Sistemden günlük 20µg dozunda levonorgestrel salınır ve endometrial büyüme baskılanır. Geniş bir kullanım alanı olan sistemin, menstrüel kan akımını azaltma ve dismenore ve endometriozis semptomlarında düzelme gibi yararları vardır. Çok sayıda çalışmada, levonorgestrel salan intrauterin sistem kullanan kadınlarda menorajide iyileşme olduğu ve leiomiyom varlığında miyom boyutlarında azalma olduğu bildirilmiştir. Bu sonuçlar operatif tedavilere olan ihtiyacı azaltmakta ve yaşam kalitesini arttırmaktadır. Hormon replasman tedavisinde, tedaviye devamsızlığa sebep olan yan etkilerin çoğu progesteronlarla ilgilidir. Ancak levonorgestrel salan intrauterin sistem yoluyla lokal salınan progesteron ile kombine edilmiş hormon tedavisi endometriumu hiperplaziden korur ve geri çekilme kanamalarını önler. Bu yazıda levonorgestrel salan intrauterin sistemin, kontrasepsiyon dışı tedavi amaçlı kullanımları derlenmiştir.

Anahtar Kelime: Rahim içi araçlar Menoraji Hormon replasman tedavisi Levonorgestrel

Konular: Kadın Hastalıkları ve Doğum

Therapeutic use of the levonorgestrel releasing intrauterine system

Öz:

Levonorgestrel intrauterine system is originally developed for contraception. The levonorgestrel, released from an intrauterine system at rate of 20µg/24 hours, suppresses endometrial growth. This system provides a broad spectrum of noncontraceptive health benefits including decreasing menstruel blood loss, reduction in symptoms of endometriosis and dysmenorrhea. Several trials revealed a reduction of menorrhagia in women using levonorgestrel intrauterine system as well as reduction of leiomyoma size. These results reduce the need for operative treatments and improve the quality of life. Most side effects and reasons for termination of hormone replacement therapy are related to the progestin component. But, hormone replacement therapy with the local delivery via levonorgestrel intrauterine system is effective in protecting the endometrium against hyperplasia, and will make withdrawal bleeding unnecessary. In this paper we review therapeutic use of the levonorgesterel system in non-contraceptional conditions.

Anahtar Kelime: Menorrhagia Hormone Replacement Therapy Levonorgestrel Intrauterine Devices

Konular: Kadın Hastalıkları ve Doğum

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Andersson K, Odling V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: A randomized comparative trial. Contraception 1994;37:44-72. 2. Lee P. Shulman, Anita L. Nelson, Philip D. Darney. Recent developments in hormone delivery systems. Am J Obstet Gynecol 2004;190:27-36. 3. Wildemeersch D and Dhont M. Treatment of non atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system. Am J Obstet Gynecol 2003;188:1177-8. 4. Bahamondes L, Ribeiro-Huguet P, De Andrade KC, Leon Martinas O, Petta CA. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003;82:448-2. 5. Suhonen S, Haukkaama M, Jakobsson T, Rauramo I. Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: A comparative study. Contraception 2004;69: 287-92. 6. Luukkainen T. The levonorgestrel intrauterine system: Therapeutic aspects. Steroids 2000;53:699-702. 7. Critchley HOD, Wang H, Kelly RW, Gebbie AE, Glasier AF. Progestin receptor isoforms and prostaglandin dehydrogenase in the endometrium of women using a levonorgestrel-releasing intrauterine system. Hum Reprod 1998; 13(5):1210-7. 8. Pengdi Z, Xiaoqun L, Hongzhi L, Zhao G, Jie C, Ruhua X, Shizhu L, Shangchun W, Jiedong W. The effect of a levonorgestrel-releasing intrauterine device on human endometrial oestrogen and progesterone receptors after one year of use. Hum Reprod 1999;14(4):970-5. 9. Roopa BA, Loganath A, Singh K. The effect of a levonorgestrel-releasing intrauterine system on angiogenic growth factors in the endometrium. Hum Reprod 2003;18(9):1809-19. 10. Fernandez JBL, Maruo T, Pakarinen P, Spitz IM, Johansson E. Effects of a levonorgestrel-releasing intra-uterine system on the expression of vascular endothelial growth factor and adrenomedullin in the endometrium in adenomyosis. Hum Reprod 2003;18(4):694-9. 11. Luukkainen T, Pakarinen P, Toivonen J. Progestin-Releasing Intrauterine Systems. Semin Reprod Med 2001;19(4):235-51. 12. Maruo T, Fernandez JBL, Pakarinen P, Murakoshi H, Spitz IM, Johansson E. Effects of a levonorgestrel-releasing intra-uterine system on proliferati- on and apoptosis in the endometrium. Hum Reprod 2001;16(10):2103-8. 13. Jarvela I, Tekay A, Jouppila P. The effect of a levonorgestrel-releasing intrauterine system on uterine artery blood flow, hormone concentration and ovarian cyst formation in fertile women. Hum Reprod 1998;13(12):2179-83. 14. Stewart A, Cummins C, Gold L, Jordon R, Phillips W. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: A systematic review. Br J Obstet Gynaecol 2001;108:74-86. 15. Toivonen J, Luukkainen T. Progestin-releasing intrauterine devices. In: Bardin CW, ed. Current Therapy in Endocrinology and Metabolism. St. Louis: Mosby; 1997:149-53. 16. Shaw RW. Assessment of medical treatments for menorrhagia. Br J Obstet
Gynaecol 1994;101:15-8. 17. Anderson K, Rybo G. Levonorgestrel- releasing intrauterine device in the treatment of menorrhagia. Br J Obstet Gynaecol 1990;97:690-4. 18. Lethaby AE, Cooke I, Rees M. Progesteron/progesteron releasing intrauterine systems versus either placebo or any other medication for heavy menstrual bleeding [Cochrane Rewiew]. In: The Cochrane Library, issue 2. Oxford : Update Software:2001. 19. Xiao B, Wu SC, Chong J, Zeng T, Han LH, Luukkainen T. Therapeutic ef-
fects of the levonorgestrel-releasing intrauterine system in the treatment of idiopathic menorrhagia. Fertil Steril 2003;79(4):951-9. 20. Tang GW, Lo SS. Levonorgestrel intrauterine device in the treatment of
menorrhagia in Chinese women: Efficacy versus acceptability. Contraception 1995;39:219-5. 21. Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkila A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and noretistrone for treatment of idiopatic menorrhagia. Br J Obstet Gynaecol 1998;105:472-8. 22. Lethaby A, Augood C, Duckitt K. Nonsteroidal anti-inflammatory drugs for heavy menstrual bledding (Cochrane Review) In: The Cochrane Library, Issue 2.Oxford: Update Software;2001. 23. Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation. Randomised controlled trial of ethamsylate, mefenamic acid and tranexamic acid. Br J Obstet Gynaecol 1996;193:447-82. 24. Milsom I, Anderson K, Andersh B, Rybo G. A comparison of flurbiprofen, tranexamik acid and levonorgestrel releasing intrauterine device in the treatment of idiopatic menorrhagia. Am J Obstet Gynecol 1991;152:879-83. 25. Romer T. Prospective comparison study of levonorgestrel IUD versus Roller-Ball endometrial ablation in the management of refractory recurrent hypermenorrhea. Eur J Obstet Gynecol Reprod Biol 2000;90(1):15-9. 26. Crosignani PG, Vercellini P, Mosconi P, Oldani S, Cortesi I, De Giorgi O. Levonorgestrel-releasing intrauterine device versus hysteroscopic endometrial resection in the treatment of dysfunctional uterine bleeding. Obstet Gynecol 1997;90:245-131. 27. Olav I, Trolle B. Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection. Fertil Steril 2001;76(2):184-9. 28. Hurskainen R, Teperi J, Aalto AM, Grenman S, Kivela A, Kujansuu E, Vuorma S, Yliskoski M, Rissanen P, Paavonen J. Levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of essential menorrhagia: Predictors of outcome. Acta Obstet Gynecol Scand 2004;83:281-3. 29. Monteiro I, Bahamondes L, Diaz J, Perotti M, Petta C. Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: A pilot study. Contraception 2002;53:205-8. 30. Barrington JW, Bowen-Simpkins. The levonorgestrel intrauterine system in the management of menorrhagia. Br J Obstet Gynaecol 1997;104:494-6. 31. Lahteenmaki P, Haukkamaa M, Puolakka J, Riikonen U, Sainio S, Suvisaari J, Nilsson CG. Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. Br J Obstet Gynaecol 1998;196:1122-6. 32. Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivela A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: A randomised trial. Lancet 2001;225:141-7. 33. Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitte D. Hormone replacement therapy and endometrial cancer risk: A meta-analysis. Obstet Gynecol 1995;85:184-92. 34. Karakoç B, Erenus M. Compliance considerations with hormone replacement therapy. Menopause 1998;5:102-6. 35. Raudaskoski T, Tapanainen J, Tomas E, Luotola H, Pekonen F, Ronni-Sivula H, Timonen H, Riphagen F, Laatikainen T. Intrauterine 10 mcg and 20 mcg levonorgestrel system in postmenapousal women receiving oral oestrogen replacement therapy: Clinical, endometrial and metabolic response. Br J Obstet Gynaecol 2002;109:124-32. 36. Suhonen S, Holmström T, Lahteenmaki P. Three-year follow-up of use of a levonorgestrel-releasing intrauterine system in hormone replacement therapy. Acta Obstet Gynecol Scand 1997;76:133-8. 37. Andersson K, Mattsson LA, Rybo G, Stadberg E. Intrauterine release of levonorgesrel: A new way of adding progestogen in hormone replacement therapy. Obstet Gynecol 1992;79:951-7. 38. Varila E, Wahlström T, Rauramo I. A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy. Fertil steril 2001;76(5):969-73. 39. Wollter-Svensson LO, Stadberg E, Andersson K, Mattsson LA, Odlind V, Persson I. Intrauterine administration of levonorgestrel 5 and 10 mcg/24 hours in perimenopausal hormone replacement therapy. Acta Obstet Gynecol Scand 1997;76:329-42. 40. Wildemeersch D, Schacht E, Wildemeersch P. Contraception and treatment in the perimenopause with a novel ‘frameless’ intrauterine levonorgestrel-releasing drug delivery system: An extended pilot study. Contraception 2002;54:93-9. 41. Wildemeersch D, Schacht E. Endometrial suppression with a new ‘frameless’ levonorgestrel releasing intrauterine system in perimenopausal and postmenopausal women: A pilot study. Maturitas 2000;24:51-8. 42. Raudaskoski TH, Tomas EI, Paakkari IA, Kauppila AJ, Laatikainen TJ. Serum lipids and lipoproteins in postmenopausal women receiving transdermal oestrogen in combination with a levonorgestrel-releasing intrauterine device. Maturitas 1995;22:35-41. 43. Suvanto-Luukkonen E, Sundström H, Penttinen J, Kauppila A. Lipid ef- fects of an intrauterine levonorgestrel device or oral vs. vaginal natural progesterone in postmenopausal women treated with percutaneous estradiol. Arch Gynecol Obstet 1998;129:201-8. 44. Vercellini P, Aimi G, Panazza S, De Giorgi O, Pesole A, Crosignani PG. A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: A pilot study. Fertil Steril 1999;72:385-8. 45. Xiao BL, Zeng T, Wu S. Effect of levonorgestrel-releasing intrauterine device on hormonal profile and menstrual pattern after long-term use. Contraception 1995;39:227-53. 46. Pakarinen PI, Suvisaari J, Luukkainen T, Lahteenmaki P. Intracervical and fundal administration of levonorgestrel for contraception: Endometrial thickness, patterns of bleeding, and persisting ovarian follicles. Fertil Steril 1997;68:47-52. 47. Fedele L, Bianchi E, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 1997;68:294-9. 48. Yoke-Fai Fong and Kuldip Singh. Medical Treatment of Grossly Enlarged Adenomyotic uterus with the levonorgestrel releasing intrauterine system. Contraception 1999;48:173-5. 49. Grigorieva V, Chen-Mok M, Tarasova M, Mikhailov A. Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomas. Fertil Steril 2003;79(5):1194-8. 50. Yoke-Fai Fong and Kuldip Singh. Effect of LNG IUS on uterine myomas in a renal transplant patient. Contraception 1999;48:39-3. 51. Pekonen F, Nyman T, Lahteenmaki P, Haukkamaa M, Rutanen EM. Intrauterine progestin induces continous insulin like growth factor-binding protein-1 production in the human endometrium. J Clin Endocrinol Metabol 1992; 5: 528-52. 52. Gardner FJE, Konje JC, Abrams KR, Brown LJR, Khanna S, Al-Azzawi F, Bell SC, Taylor DJ. Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: A randomised controlled trial. Lancet 2000;224:1711-7. 53. Inki P, Hurskainen R, Palo P, Ekholm E, Grenman S, Kivela A, Kujansuu E, Teperi J, Yliskoski M, Paavonen J. Comparison of ovarian cyst formation in women using the levonorgestrel-releasing intrauterine system vs. hysterectomy. Ultrasound Obstet Gynecol 2002;20:249-5. 54. Bahamondes L, Hidalgo M, Petta CA, Diaz J, Espejo-Arce X, Monteiro-Dantas C. Enlarged ovarian follicles in users of a levonorgestrel-releasing intrauterine system and contraceptive implant. J Reprod Med 2003;36:505-28.

APA	TAŞKIN S, ÖZMEN B, Ünlü M (2006). Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. , 63 - 67.
Chicago	TAŞKIN Salih,ÖZMEN Batuhan,Ünlü Mehmet Cihat Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. (2006): 63 - 67.
MLA	TAŞKIN Salih,ÖZMEN Batuhan,Ünlü Mehmet Cihat Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. , 2006, ss.63 - 67.
AMA	TAŞKIN S,ÖZMEN B,Ünlü M Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. . 2006; 63 - 67.
Vancouver	TAŞKIN S,ÖZMEN B,Ünlü M Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. . 2006; 63 - 67.
IEEE	TAŞKIN S,ÖZMEN B,Ünlü M "Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı." , ss.63 - 67, 2006.
ISNAD	TAŞKIN, Salih vd. "Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı". (2006), 63-67.

APA	TAŞKIN S, ÖZMEN B, Ünlü M (2006). Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. Journal of the Turkish-German Gynecological Association, 7(1), 63 - 67.
Chicago	TAŞKIN Salih,ÖZMEN Batuhan,Ünlü Mehmet Cihat Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. Journal of the Turkish-German Gynecological Association 7, no.1 (2006): 63 - 67.
MLA	TAŞKIN Salih,ÖZMEN Batuhan,Ünlü Mehmet Cihat Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. Journal of the Turkish-German Gynecological Association, vol.7, no.1, 2006, ss.63 - 67.
AMA	TAŞKIN S,ÖZMEN B,Ünlü M Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. Journal of the Turkish-German Gynecological Association. 2006; 7(1): 63 - 67.
Vancouver	TAŞKIN S,ÖZMEN B,Ünlü M Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı. Journal of the Turkish-German Gynecological Association. 2006; 7(1): 63 - 67.
IEEE	TAŞKIN S,ÖZMEN B,Ünlü M "Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı." Journal of the Turkish-German Gynecological Association, 7, ss.63 - 67, 2006.
ISNAD	TAŞKIN, Salih vd. "Levonorgestrel salan intrauterin sistemin tedavi amaçlı kullanımı". Journal of the Turkish-German Gynecological Association 7/1 (2006), 63-67.