Sabbioni Lorenzo, Petraglia Felice, Luisi Stefano
a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy.
Gynecol Endocrinol. 2017 Nov;33(11):822-829. doi: 10.1080/09513590.2017.1334198. Epub 2017 Jun 6.
Levonorgestrel intrauterine systems (LNG-IUS) represent a modern therapy for an array of preexisting gynecological conditions, though they were first marketed in Finland in 1990. However, there are countries in which their use is extremely limited by social and cultural factors. This manuscript describes the possible reasons for this misuse, taking in consideration the clinical noncontraceptive benefits of intrauterine levonorgestrel in routinary practice. Medical diseases in which LNG-IUS represent a treatment include abnormal uterine bleeding, iron-deficiency anemia, endometrial hyperplasia, uterine fibroids, adenomyosis, endometriosis, and coagulopathies. The advantage of reducing the need for more radical treatments such as surgery or hysterectomy is well demonstrated, with remarkable benefits for patients. However, in many countries, surgery is still used as a first-line treatment and there is a need to define who could benefit from a less invasive option. It seems clear that such a reduced use of LNG-IUS depends on factors that imply both patients and practitioners, and that the role of counseling is becoming a key component in the decision-making process to reach the ultimate goal of compliance.
左炔诺孕酮宫内节育系统（LNG-IUS）是治疗一系列既有妇科疾病的现代疗法，尽管其于1990年在芬兰首次上市。然而，在一些国家，其使用受到社会和文化因素的极大限制。本手稿考虑到宫内左炔诺孕酮在常规临床中的非避孕益处，描述了这种使用受限的可能原因。LNG-IUS可用于治疗的医学疾病包括异常子宫出血、缺铁性贫血、子宫内膜增生、子宫肌瘤、子宫腺肌病、子宫内膜异位症和凝血障碍。减少手术或子宫切除术等更激进治疗需求的优势已得到充分证明，对患者有显著益处。然而，在许多国家，手术仍被用作一线治疗方法，因此有必要确定谁能从侵入性较小的治疗方案中获益。很明显，LNG-IUS使用减少取决于患者和从业者两方面的因素，而咨询的作用正成为决策过程中的关键组成部分，以实现依从性这一最终目标。
