The promise and reality of the intrauterine route for hormone delivery for prevention and therapy of gynecological disease.
BACKGROUND
Progestins delivered by a variety of routes have been demonstrated, in addition to their high contraceptive effect, to have substantial benefits in the treatment of various gynecological disorders, and the intrauterine route has particular efficacy in treating endometrial and myometrial disorders. It should be possible to extend this to prevention of disease.
Those conditions for which there is most evidence of therapeutic benefit from intrauterine release of progestins include heavy menstrual bleeding (due to most causes), endometrial hyperplasia, endometriosis and adenomyosis.
Reasonable evidence exists to support the findings that intrauterine levonorgestrel helps to prevent the development of uterine fibroids, endometriosis, endometrial hyperplasia, acute episodes of pelvic infection and a wide range of menstrual symptoms. There is also promise of prevention of endometrial carcinoma, endometrial polyps, infertility and perhaps adenomyosis.


CONCLUSIONS
There is a need for specific studies to further explore the prevention of these gynecological conditions which can cause major health disturbances and community distress.
Fraser
Ian S
IS
Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, NSW 2006, Australia. helena@med.usyd.edu.au
D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use; D011372:Progestins / Q000627:therapeutic use; D014591:Uterine Diseases / Q000188:drug therapy / Q000517:prevention & control*; D014599:Uterus / Q000187:drug effects* / Q000473:pathology
D011372:Progestins; D016912:Levonorgestrel