The clinical effects of levonorgestrel-releasing intrauterine
device (Mirena®) on adenomyosis
B.S. Lee1, S.H. Cho1, C.M. Kim1, S.H. Kim2, I.M. Lee3, K.J.
Hwang4, H.K. Lee5
1Yonsei University College of Medicine, YongDong Severance
Hospital, Seoul, Korea, South, 2Seoul National University College of Medicine,
Seoul, Korea, South, 3Soonchunhyang University College of Medicine, Seoul,
Korea, South, 4Ajou University School of Medicine, Suwon, Korea, South, 5Gachon
Medical School Gil Medical Center, Inchon, Korea, South
Objective To evaluate
the clinical effects of of levonorgestrel-releasing intrauterine device (Mirena®)
on adenomyosis using Doppler ultrasound and uterine volume.
Methods From
January, 2003 to December, 2005, the levonorgestrel-releasing intrauterine
device (Mirena®) was inserted to 48 patients with adenomyosis, and the volume
of uterus and uterine artery blood flow were measured with color Doppler
transvaginal ultrasound. The degree of dysmenorrhea was evaluated at the time of
intrauterine device insertion with visual analogue scale. After 12 months,
changes of the volume of the uterus, uterine artery blood flow, pain score and
serum CA-125 levels were evaluated. For 24 patients, the volume of the uterus
was followed for 2 years.
Results The mean age of the patients was 44 years old
and the mean parity was 1.81. The initial mean volume of the uterus was 159.18
± 60.69cc, and was decreased to 125.36 ± 45.28 with statistically
significance(p<0.05). The pulsatile index of uterine arteries was significantly increased after 12 months. The pulsatile index of right uterine artery increased from 1.95 ± 0.60 to 2.22 ± 0.77 and the pulsatile index of left uterine artery increased from 2.04 ± 0.52 to 2.29 ± 0.85(p<0.05). The resistance index and S/D ratio were also increased but were not statistically significant. The mean pain score was also significantly decreased from 8.33 ± 0.72 to 1.42 ± 0.65(p<0.05). The initial serum CA-125 level was slightly elevated with mean value of 39.33±23.87 U/ml. After 12 months, the level was lowered to 22.14 ± 16.47 U/ml (p<0.05). For 24 patients, the change of uterus volume was evaluated for 2 years. It was decreased with from 167.48 ± 59.09cc to 125.71 ± 42.80cc in first 12 months (p<0.05), but the volume was slightly increased to 132.39 ± 53.77cc in next 12 months.
Conclusion For adenomyosis
patients, the levonorgestrel-releasing intrauterine device (Mirena®)
effectively decreases the volume of the uterus with improvement of vascularity
and symptomatically improves dysmenorrhea within 12 months. However, the volume
tends to increase after 12 months, indicating that it may not be as effective in
management of adenomyosis after 2 years.