Yıl: 2008 Cilt: 9 Sayı: 4 Sayfa Aralığı: 202 - 205 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia

Öz:
Amaç: Bu çalışmanın amacı, menorajili kadınların tedavisinde 20 μg/gün levonorgestrel salınımlı (LNG) R‹A’nın, >2 yıl kullanım şartıyla, etkinliği, performansı ve kabul edilebilirliğinin değerlendirilmesidir. Materyal ve Metot: Bu; karşılaştırmalı olmayan, tanımlayıcı ve prospektif olan bir çalışmadır. Medikal tedavi sonrası menoraji şikâyeti olan 44 kadına (31-49 yaş aralığında) menstrüel periyodu takiben 20 μg/gün levonorgestrelli R‹A takıldı. Levonorgestrelli R‹A takılmadan önce hemoglobin değerleri ve transvajinal USG (ultrasonografi) ölçümleri ile menstrüel patternler değerlendirildi ve değerlendirme 2 yıl içinde 45 gün, 3 ay ve 6 ay aralığında tekrarlandı. Bulgular: LNG-R‹A uygulanmasından sonra en yaygın kanama paterni hafif lekelenme tarzında vajinal kanama idi ve 1 yıl sonrası nda 41 kadında (%93) amenore ya da oligomenore şikâyetleri izlendi. Üç hasta (%6.8) sürekli vajinal kanamadan dolayı LNG-R‹A’nın çıkartılmasını istedi ve 2 hasta (%4.5) kendiliğinden LNG-R‹A’yı çıkarttırmıştı. LNG-R‹A takıldıktan 1 yıl sonra hemoglobin seviyesi 10.0 mg/L’den 11.4 mg/lL’ye, 2 yıl sonra 12.8 mg/L seviyesine yükseldi. ‹ki yıl sonunda katılımcıların %88.6’sı LNG-R‹A kullanımına devam etmekte idi ve LNG-R‹A’yı kabul edilebilir bir seçenek olanak görmekte idi. Tartışma: LNG-R‹A, menorajili kadınlar için etkili bir tedavidir ve hem histerektomi veya endometriyal ablasyon tedavisini kabul etmeyen hem de bu tedavilerin kontrendike olduğu menorajili kadınlarda alternatif-kabul edilebilirliği yüksek bir tedavi yöntemidir.
Anahtar Kelime: İleriye dönük çalışma Tedavi sonucu Tedavi başarısızlığı Menoraji Levonorgestrel Rahim içi araçlar, ilaçlı

Konular: Kadın Hastalıkları ve Doğum

Levonorgestrelli rahim içi araç (RİA): Menorajinin yönetiminde etkili ve kabul edilebilir bir alternatif

Öz:
Objective: The objective of this study was to evaluate the efficacy, performance and acceptibility, for up to 2 year, of an intrauterine device releasing 20 μg/day of levonorgestrel (LNG-IUD) in the treatment of women with menorrhagia. Materials and Methods: It was a descriptive, prospective, non-comparative study. A 20 μg/day LNG-releasing-IUD was inserted following menstrual period to 44 women (between 31 and 49 years of age) who presented with menorrhagia after medical therapies had failed. Menstrual patterns were assessed, hemoglobin concentrations were measured and transvaginal sonography was done before LNG-IUD was inserted and at 45 days, 3 months and then at 6 month interval for 2 years. Results: The most common bleeding pattern at 3 months after insertion was spotting, and after 1 year and thereafter 41 women (93%) presented with amenorrhea or oligomenorrhea. Three women (6.8%) requested removal of the LNG-IUD because of continuous spotting, and two women (4.5%) expelled it spontaneously. Hemoglobin levels were improved from 10.0 mg/L to 11.4 and 12.8 mg/L at 1 and 2 year respectively, after insertion of the LNG-IUD. At end of 2 year 88.6% of participants continued the use of LNG-IUD and found it acceptable. Discussion: LNG-IUD was an effective treatment for women with menorrhagia and could be an alternative treatment for women with menorrhagia who are either contraindicated for or refuse hysterectomy or endometrial ablation. It acceptability is high.
Anahtar Kelime: Menorrhagia Levonorgestrel Intrauterine Devices, Medicated Prospective Studies Treatment Outcome Treatment Failure

Konular: Kadın Hastalıkları ve Doğum
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Banu NS, Manyonda IT. Alternative medical and surgical options to hysterectomy. Best Pract Res Clin Obstet Gynecol 2005 Jun;19(3):431-49.
  • 2. Jensen JT. Contraceptive and therapeutic effects of the levonorgestrel intrauterine system: an overview. Survey 2005 Sep;60(9):604-12. 3. Hurskainen R, Teperi J, Rissanen P et al. Quality of life and costeffectiveness
  • of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet 2001 Jan 27;357(9252):273-7.
  • 4. Hubacher D, Grimes DA. Noncontraceptive health benefits of intrauterine devices: a systematic review.Obstet Gynecol Surv 2002 Feb;57(2):120-8.
  • 5. Hurskainen R, Teperi J, Aalto AM et al. Levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of essential menorrhagia: predictors of outcome. Acta Obstet Gynecol Scand 2004 Apr;83(4):401-3.
  • 6. Hurskainen R, Teperi J, Rissanen P et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA 2004 Mar 24;291(12):1456-63.
  • 7. Fedele L, Bianchi S, Raffaelli R, et al. Fertil Steril 1997 Sep; 68(3):426-9.
  • 8. Lockhat FB, Emembolu JO, Konje JC. Obstet Gynecol Surv 2005 Jul; 60(7):443-5.
  • 9. Lethaby AE, Cooke I, Rees M. Progesterone/progestogen releasing intrauterine systems versus either placebo or any other medication for heavy menstrual bleeding. Cochrane Database Syst Rev 2000;(2):CD002126.
  • 10. Abou-Setta AM, Al-Inany HG, Farquhar CM. Levonorgestrelreleasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database of Systematic Reviews 2006, Issue 4.
  • 11. Reid PC, Virtanen-Kari S. Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts. BJOG 2005 Aug;112(8):1121-5.
  • 12. Bratschi HU. Hysteroscopic endometrial resection. Contrib Gynecol Obstet 2000;20:121-36.
  • 13. Nina K, Olav I. Gynecological Endoscopy 1998;7:61-5.
  • 14. Wildemeersch D, Dhont M. Treatment of nonatypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system. Am J Obstet Gynecol 2003 May;188(5):1297-8.
  • 15. Dhar KK, NeedhiRajan T, Koslowski M, Woolas RP. Is levonorgestrel intrauterine system effective for treatment of early endometrial cancer? Report of four cases and review of the literature. Gynecol Oncol 2005 Jun;97(3):924-7.
  • 16. Riva H, Juha T, Pekka R. The Lancet 2001;357:273-7.
APA BAXI A, KAUSHAL M, GHOSH A (2008). The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. , 202 - 205.
Chicago BAXI Asha,KAUSHAL Manila,GHOSH Anshu The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. (2008): 202 - 205.
MLA BAXI Asha,KAUSHAL Manila,GHOSH Anshu The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. , 2008, ss.202 - 205.
AMA BAXI A,KAUSHAL M,GHOSH A The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. . 2008; 202 - 205.
Vancouver BAXI A,KAUSHAL M,GHOSH A The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. . 2008; 202 - 205.
IEEE BAXI A,KAUSHAL M,GHOSH A "The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia." , ss.202 - 205, 2008.
ISNAD BAXI, Asha vd. "The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia". (2008), 202-205.
APA BAXI A, KAUSHAL M, GHOSH A (2008). The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. Journal of the Turkish-German Gynecological Association, 9(4), 202 - 205.
Chicago BAXI Asha,KAUSHAL Manila,GHOSH Anshu The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. Journal of the Turkish-German Gynecological Association 9, no.4 (2008): 202 - 205.
MLA BAXI Asha,KAUSHAL Manila,GHOSH Anshu The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. Journal of the Turkish-German Gynecological Association, vol.9, no.4, 2008, ss.202 - 205.
AMA BAXI A,KAUSHAL M,GHOSH A The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. Journal of the Turkish-German Gynecological Association. 2008; 9(4): 202 - 205.
Vancouver BAXI A,KAUSHAL M,GHOSH A The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia. Journal of the Turkish-German Gynecological Association. 2008; 9(4): 202 - 205.
IEEE BAXI A,KAUSHAL M,GHOSH A "The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia." Journal of the Turkish-German Gynecological Association, 9, ss.202 - 205, 2008.
ISNAD BAXI, Asha vd. "The levonorgestrel intrauterinedevice: An effective and acceptable alternative for the management of menorrhagia". Journal of the Turkish-German Gynecological Association 9/4 (2008), 202-205.