Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging.
BACKGROUND
This study was conducted to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on adenomyotic lesions diagnosed and monitored by magnetic resonance imaging (MRI).


METHODS
LNG-IUS was inserted during menstrual bleeding in 29 women, 24 to 46 years of age, with MRI-diagnosed adenomyosis associated with menorrhagia and dysmenorrhea. Clinical evaluations were carried out at baseline and at 3 and 6 months postinsertion. MRI was performed at baseline and at 6 months postinsertion and was used to calculate junctional zone thickness (in mm), to define the junctional zone borders, to identify the presence of high-signal foci on T(2)-weighted images and to calculate uterine volume (in mL).


RESULTS
A significant reduction of 24.2% in junctional zone thickness was observed (p<.0001); however, no significant decrease in uterine volume was observed (142.6 mL vs. 136.4 mL; p=.2077) between baseline and the 6-month evaluation. A significant decrease in pain score was observed at 3 and 6 months after insertion (p<.0001); however, six women continued to report pain scores >3 at 6 months of observation. At 3 months of use, the most common bleeding pattern was spotting, and at 6 months of observation, oligomenorrhea was the most common pattern observed, although spotting was present in one third of the women.


CONCLUSIONS
The insertion of an LNG-IUS led to a reduction in pain and abnormal bleeding associated with adenomyosis. MRI was useful for monitoring response of adenomyotic lesions to the LNG-IUS.
Bragheto
Aristides M
AM
Human Reproduction Unit, Department of Obstetrics and Gynecology, Campinas, 13084-971 SP, Brazil.
Caserta
Nelson
N
Bahamondes
Luis
L
Petta
Carlos A
CA
D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004715:Endometriosis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014591:Uterine Diseases / Q000188:drug therapy* / Q000473:pathology; D014599:Uterus / Q000473:pathology*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel