Faculdade Municipal Professor Franco Montoro, Brazil; Personna Center of Gynecology and Woman's Health, Brazil.
Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2022 Sep;276:56-62. doi: 10.1016/j.ejogrb.2022.06.029. Epub 2022 Jul 2.
The aim of our study was to evaluate the effects of the LNG-IUS on uterine volume, bleeding patterns, and LNG-IUS-related outcomes among women using the device to treat abnormal uterine bleeding caused by fibroids, adenomyosis, HMB (without structural cause), or contraception.
This was a 5-year cohort study with LNG-IUS users. We selected 147 women, who were allocated to four groups: a) control (contraception indication); b) fibroids; c) adenomyosis; d) HMB. The visits for clinical and ultrasound evaluations were made at baseline and at 3, 6, 12, 24, 36, 48, and 60 months postinsertion. All data are expressed as mean and standard deviation (SD) or absolute and relative (%) frequency. Differences among groups were established by using the χ2 (chi-square) test and Fisher's exact tests for categorical outcomes, as well as the Mann-Whitney and the Kruskal-Wallis tests and Friedman's ANOVA for continuous variables. We used the 5% significance level as an indication of statistical significance. Logistic regression analyses were performed to study the association between predictors and outcomes. Results are expressed as odds ratios (ORs) with a 95% confidence interval (CI 95%).
Although all groups had real rates of bleeding patterns, troublesome bleeding appeared to be more frequent in the fibroid group (∼15%). Also, along the 60 months of follow-up, uterine volume slightly decreased in the groups of HMB, adenomyosis, and fibroids, but not in the contraception group. However, the isolated volume of fibroids remained unchanged. In this cohort, we observed high continuation rates among LNG-IUS users. The uterine volume ≥200 cm was the main predictor of hysterectomy or IUS expulsion in the adenomyosis and fibroid groups.
The LNG-IUS may control uterine menstrual bleeding as well as uterine volume in adenomyosis, fibroids, and HMB. An initial uterine volume smaller than 200 cm is an important predictor of adherence to treatment and better outcomes.
我们研究的目的是评估 LNG-IUS 对因子宫肌瘤、子宫腺肌病、HMB（无结构原因）或避孕而导致异常子宫出血的女性的子宫体积、出血模式和 LNG-IUS 相关结局的影响。
这是一项为期 5 年的 LNG-IUS 使用者队列研究。我们选择了 147 名女性，将她们分为四组：a）对照组（避孕指征）；b）子宫肌瘤组；c）子宫腺肌病组；d）HMB 组。在基线和插入后 3、6、12、24、36、48 和 60 个月时进行临床和超声评估。所有数据均表示为均值和标准差（SD）或绝对和相对（%）频率。使用 χ2（卡方）检验和 Fisher 确切检验比较组间的差异，对于连续变量使用 Mann-Whitney 和 Kruskal-Wallis 检验和 Friedman 的 ANOVA。我们使用 5%的显著性水平作为统计学意义的指示。进行逻辑回归分析以研究预测因子与结局之间的关系。结果表示为比值比（OR）和 95%置信区间（95%CI）。
尽管所有组都有真实的出血模式发生率，但子宫肌瘤组似乎更频繁地出现麻烦性出血（约 15%）。此外，在 60 个月的随访期间，HMB、子宫腺肌病和子宫肌瘤组的子宫体积略有减小，但避孕组没有。然而，孤立的子宫肌瘤体积保持不变。在该队列中，我们观察到 LNG-IUS 使用者的高续用率。子宫体积≥200cm3 是子宫腺肌病和子宫肌瘤组行子宫切除术或 IUS 取出的主要预测因素。
LNG-IUS 可控制子宫腺肌病、子宫肌瘤和 HMB 的子宫月经出血和子宫体积。初始子宫体积小于 200cm3 是治疗依从性和更好结局的重要预测因素。
