A non-contraceptive use of the levonorgestrel-releasing intrauterine
system: management of endometrial hyperplasia
Z. Sgarbura (1), O. Sgarbura (2), M. Zaharia (1), I. Antohi (1)
Filantropia University Hospital, Bucharest, Romania (1); Carol Davila
University of Medicine and Pharmacy, Bucharest, Romania (2)
Introduction: The levonorgestrel- releasing intrauterine system (LNG-IUS)
has been developed as a long-acting reversible method of contraception but it
offers not only contraceptive efficacy but also potential therapy for a number
of gynaecological disorders. The direct action of the daily dose of 20 µg LNG
on the endometrium achieves uniform suppression of endometrial proliferation
that becomes unresponsive to estrogens.
Material and Methods: It is a prospective study that enrolled 2 groups
of 30 women aged 33 to 40. The study was designed in order to evaluate the
impact of LNG on the management of endometrial hyperplasia. In the study group
the IUS was inserted in the first decade of the menstrual cycle meanwhile the
control group received didrogesterone 20 mg daily starting with day 14. The
preliminary investigations were: Pap test, colposcopy, transvaginal ultrasound,
hysteroscopy and hystopathological endometrial sampling. The considered
variables were: blood loss, endometrial thickness and histological diagnosis.
The results were analyzed with t-student test and chi-square test.
Results: The blood loss was significantly reduced in the period
following the treatment in the study group compared to control group (82% vs.
57%, p=0,02). The transvaginal ultrasound evaluation of the endometrial
thickness confirmed this data and was, furthermore, confirmed histologically.
Conclusion: The strong anti-proliferative action on the endometrium
explains the potential use of LNG-IUS in the treatment of the menorrhagia,
reduction of dysmenorrhea, management of symptomatic endometriosis and
adenomyosis, the endometrial protection during estrogen replacement therapy and
the management of endometrial hyperplasia.
