The levonorgestrel intrauterine system with a transdermal estrogen for
climacteric complaints: clinical and endometrial responses
V.N. Prilepskaya, L.I. Ostreikova
Research Centre of Obstetrics and Gynecology and Perinatology, Academy of
Medical Sciences of the Russian Federation, Moscow, Russia
The aim of this research was to study clinical efficiency and acceptability
of transdermal estrogen (Klimara) in combination with levonorgestrel
intrauterine system (LNG-IUS) for the treatment of climacteric complaints of
premenopause women as well as to determine the influence of LNG-IUD on the
condition of endometrium.
Material and method: We had twenty five premenopause women. The
average age of the subjects was ranging from 45 to 52 years.We dealt with
patients seeking treatment for climacteric symptoms. Major complaints were hot
flushes, sweating, sleep disturbances and irritability or depression. These
climacteric symptoms appeared against delay periods.
Methods of investigation: We used Kupperman index to describe
climacteric symptoms; serum concentration of estradiol was thoroughly observed
within the period of a 1-year treatment. The efficiency of the progestin therapy
was controlled by transvaginal ultrasonography and by the examination of biopsy
samples obtained. The duration of follow-up was 12 months. The intervals of
follow-up were 6 months.
Results: Curing effect on climacteric symptoms was observed in
decrease or disappearance of hot flushes and hypergedroses in 3 months’ time
(45%). After 6 months Kupperman index became noticeably lower (p50.01). During
the follow-up year, serum estradiol concentration got significantly higher
(p50.0001) and the average concentration was 182+17 pg/ml after 6 months and 260
+19 pg/ml after 12 months. During the first half of the follow-up year, 32% of
the women had amenorrhea and one year after the beginning of the study their
number rose up to 84%. Histological examination showed that the typical finding
in the endometrium was without any indications of functional activity with 90%
of women. Intrauterine levonorgestrel-releasing system induces the
transformation of the endometrium characterised by extensive decidualisation of
the stroma, cells associated with leukocyte infiltrate, atrophy of the glandular,
glandular epithelium of the indifferent type. After 12 months’ therapy, all
women had atrophic epithelium with pronounced decidual reaction in the stroma.
No signs of proliferation were observed in any of the endometrial samples.
Conclusion: Thus, levonorgestrel intrauterine system with estrogen in
HRT is an effective and acceptable method of treating climacteric symptoms. It
is extraordinarily important that the progesterone released from the IUD
prevents the endometrial proliferation induced by estrogen.