Use of a levonorgestrel-releasing intrauterine device for the symptomatic treatment of uterine myomas.
OBJECTIVE
To assess the effect of a levonorgestrel-releasing intrauterine device (LNG-IUD) for the treatment of women with uterine myomas with increased bleeding by measuring total uterine volume and by determining patient clinical improvement, uterine artery flow velocity and hemoglobin levels.


METHODS
Ten patients with a complaint of increased uterine bleeding associated with the presence of uterine myomas were assessed in a descriptive case series and studied before and 6 months after placement of an LNG-IUD. The patients were assessed for intensity of bleeding, uterine volume, Doppler velocimetry of the uterine arteries, hematocrit and hemoglobin.


RESULTS
One patient asked to be released from the study 15 days after LNG-IUD insertion, claiming the occurrence of increased bleeding, and 2 patients underwent spontaneous expulsion of the device after 2 and 4 months of follow-up. Of the 7 patients who continued the study, 3 started to present a bleeding pattern of the oligomenorrhea type, and the other 4 experienced amenorrhea. All patients (n = 6) with anemia at the beginning of the study presented normalization of hematocrit and hemoglobin levels after 6 months of treatment (p=0.0003 and p <0.0001, respectively). However, we observed no reduction in uterine volume (p = 0.11) or flow velocity assessed by the uterine artery pulsatility index (right, p=0.17; left, p=0.19) and of the series resistance index (right, p = 0.54; left, p =0.31) using Doppler velocimetry.


CONCLUSIONS
Use of an LNG-IUD may be effective in controlling uterine bleeding secondary to myomatosis even in the absence of reduction of uterine volume.
Rosa e Silva
Julio Cesar
JC
Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil. juliocrs@convex.com.br
de Sá Rosa e Silva
Ana Carolina Japur
AC
Cândido dos Reis
Francisco Jose
FJ
Manetta
Luís Alberto
LA
Ferriani
Rui Alberto
RA
Nogueira
Antônio Alberto
AA
D000328:Adult; D000740:Anemia / Q000209:etiology / Q000517:prevention & control; D001783:Blood Flow Velocity; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008595:Menorrhagia / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009214:Myoma / Q000097:blood / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014594:Uterine Neoplasms / Q000097:blood / Q000150:complications / Q000628:therapy*; D014599:Uterus / Q000098:blood supply / Q000187:drug effects
D003271:Contraceptive Agents, Female; D006454:Hemoglobins; D016912:Levonorgestrel