title: Insertion of the Mirena intrauterine system for treatment of adenomyosis-associated menorrhagia: a novel method.
abstract: OBJECTIVE
  Insertion of the levonorgestrel-releasing intrauterine system Mirena is difficult in women with adenomyosis, and the device is often subsequently expelled. We used a novel insertion technique (Yang's method) to overcome this problem.
  
  
  METHODS
  This retrospective study enrolled 273 patients with adenomyosis who were receiving Mirena for treatment of menorrhagia and/or dysmenorrhea between 2001 and 2008. Clinical outcomes and expulsion rates were compared between patients treated using conventional insertion and those treated using Yang's insertion methods.
  
  
  RESULTS
  Expulsion occurred in 25.3% of patients with the conventional method, compared with 10.2% of patients with Yang's method. Hemoglobin levels and dysmenorrhea improved greatly in both groups after Mirena insertion.
  
  
  CONCLUSIONS
  Yang's insertion method for levonorgestrel-releasing intrauterine system is more reliable in some difficult cases, such as patients with severe adenomyosis. This method ensures correct positioning, thus reducing the risks of uterine perforation and/or expulsion.
authors: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Fu-Shaing
authors: FS
authors: Peng
authors: Ming-Yih
authors: MY
authors: Wu
authors: Jehn-Hsiahn
authors: JH
authors: Yang
authors: Shee-Uan
authors: SU
authors: Chen
authors: Hong-Nerng
authors: HN
authors: Ho
authors: Yu-Shih
authors: YS
authors: Yang
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004412:Dysmenorrhea / Q000209:etiology / Q000628:therapy; D004715:Endometriosis / Q000150:complications*; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage; D008595:Menorrhagia / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000150:complications*
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel