Efficacy of the levonorgestrel intrauterine system in treating menorrhagia: actualities and ambiguities.
OBJECTIVE
To review the literature on usage of the levonorgestrel intrauterine system (LNG IUS) in women with fibroids or adenomyosis in an attempt to develop a pragmatic approach when faced with enlarged uteri.


METHODS
Computerised searches of MEDLINE and EMBASE up to December 2000. Some of the information was obtained from references listed in the primary sources and references already known to the authors.


METHODS
Studies and case reports were excluded if they did not specifically provide information about LNG IUS usage in women with fibroids and adenomyosis.


METHODS
After perusal, each relevant publication was summarised and appraised in terms of whether it contained information relevant to the stated objective.


CONCLUSIONS
This area is sparsely researched, as there were no randomised-controlled studies. One large contraceptive study suggests the LNG IUS has a protective effect from the complications of uterine fibroids and smaller case studies suggest it is also useful in women with symptomatic fibroids. However, there is also evidence of an increased risk of expulsion and there may be a place for initial adjunctive medical treatment to minimise this risk. An observational study and isolated reports of women with adenomyosis report significant symptomatic relief in these women.


CONCLUSIONS
Available data refute the notion that uterine enlargement is a contraindication to insertion of the LNG IUS, but there appear to be reasons for a cautious approach when dealing with pathological uteri.
Ikomi
Amaju
A
Department of Obstetrics and Gynaecology, Basildon Hospital, Essex, UK.
Pepra
Eric F
EF
D004715:Endometriosis / Q000150:complications; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D007889:Leiomyoma / Q000150:complications; D016912:Levonorgestrel; D008595:Menorrhagia / Q000209:etiology / Q000628:therapy*; D045167:Progesterone Congeners; D014591:Uterine Diseases / Q000150:complications; D014594:Uterine Neoplasms / Q000150:complications
D045167:Progesterone Congeners; D016912:Levonorgestrel