Clinical analysis of GnRH-a combined with LNG-IUS in the treatment of adenomyosis by different uterine volume
- Author:
Jing YUAN
1
;
Hua DUAN
1
;
Ge MENG
1
;
Rui-juan FANG
1
;
Jin-juan WANG
1
Author Information
- Publication Type:Journal Article
- Keywords: adenomyosis; gonadotropin-reteasing hormone agonist; dysmenorrhea; menorrhagia; levonorgestrel-releasing intrauterine system; adverse reaction
- From: Chinese Journal of Practical Gynecology and Obstetrics 2019;35(08):910-914
- CountryChina
- Language:Chinese
- Abstract: OBJECTIVE: To investigate the effect of different uterine volume on the therapeutic effect of GnRH-a combined with levonorgestrel-releasing intrauterine system(LNG-IUS)in the treatment of adenomyosis.METHODS: From July 2014 to December 2017 in Center of Minimally Invasive Gynecology,Beijing Obstetrics and Gynecology Hospital,160 patients with adenomyosis were divided into experimental group and control group according to the volume of uterine cavity before inserting LNG-IUS.The experimental group(n=80)was inserted LNG-IUS when the uterine volume ≥100 cm~3.The control group(n=80)was inserted LNG-IUS when the uterine volume<100 cm~3.All patients were followed up for 12 months,and the treatment effect and adverse reactions were compared between the two groups.RESULTS:(1)After placement of LNG-IUS,scores of pain and the amount of menstrual blood had decreased significantly in the two groups(In the experimental group and control group the scores of pain before insertion,and 3 months,6 months and 12 months after placement of LNG-IUS was7.38±2.52,3.23±1.81,1.92±1.53 and 1.69±2.18;7.66±1.99,2.94 ± 1.88,1.56 ± 1.29 and 1.18 ± 1.41.And the amount of menstrual blood was 151.78±38.28,74.00±20.05,54.86±14.71 and 35.35±11.57;117.59±21.20,57.86±18.29,42.37±11.88 and 31.08±9.90),the decline in the control group was greater than that of the experimental group(P=0.000).(2)The incidence of vaginal spotting of experimental group was higher than that of the control group at 3 months and 6 months after the placement of LNG-IUS.There was no significant difference between the two groups at 12 months after the placement of LNG-IUS(the incidence of vaginal spotting in the experimental group was 55.0%,46.3% and25.0%,and 37.5%,30.0% and 15.0% in the control group.The P values of the two groups after 3 months,6 months,and12 months were 0.026,0.034 and 0.114,respectively).The incidence of abdominal pain and backache decreased with the placement time(the incidence was 26.3%,18.8%,and 6.3% in the experimental group,and 18.8%,12.5% and 3.8% in the control group.The P values of the two groups was 0.03 and 0.012).There was no significant difference in amenorrhea,weight gain and other side effects between the two groups(P>0.05).(3)The fall-off rate and LNG-IUS drop rate in the experimental group were higher than those in the control group(The fall-off rate was 15.0% and 5.0% in the two groups,P=0.035.The LNG-IUS drop rate was 25.0% and 12.5% in the two groups,P=0.043).(4)The uterine volume,the depth of uterine cavity and the amount of menstruation before insertion were risk factors which affected the fall-off/drop rate of LNG-IUS.When the uterine volume was greater than 97.33 cm~3,the prediction sensitivity was 96.0% and the specificity was 58.3%.When the depth of uterine cavity was greater than 8.75 cm,the prediction sensitivity was 92.0% and the specificity was 53.3%.CONCLUSION: Excessive uterine volume affects the efficacy of LNG-IUS in the treatment of adenomyosis.When the uterine volume is greater than 97.33 cm~3,or the depth of uterine cavity is greater than 8.75 cm before placement of LNG-IUS,the fall-off/drop rate is significantly increased.
