title: Levonorgestrel-releasing intrauterine device in the treatment of abnormal uterine bleeding: a 6- and 12-month morphological and clinical follow-up.
abstract: BACKGROUND
  Abnormal uterine bleeding is defined as any alteration in the pattern or volume of menstrual blood flow, and it is preferably treated using hysterectomy, endometrial destruction or the levonorgestrel-releasing intrauterine system (Mirena(®) ). Recently, it has been demonstrated that studies of Mirena(®) were generally small and consequently imprecise.
  
  
  OBJECTIVE
  Our study was aimed at assessing the effects of a slow-release levonorgestrel (20 μg/day) intrauterine device in fertile and postmenopausal women experiencing abnormal uterine bleeding that did not respond to traditional medical management.
  
  
  METHODS
  A total of 40 women, of whom 24 were of reproductive capacity and 16 were postmenopausal, were enrolled in the trial. Removal of the intrauterine device was required for only 2 of the 24 fertile women and for only 3 of the 16 postmenopausal women. After 6 and 12 months of treatment, the remaining women were clinically evaluated and underwent ultrasound and hysteroscopy using biopsy specimens as a control. The EuroQol Group EQ-5D questionnaire was used for evaluation of quality of life.
  
  
  RESULTS
  The device showed good tolerability and efficacy. It resulted in a reduction in the endometrial mucosal thickness with a regression of bleeding and collateral effects, which were more evident after 12 months of treatment. A positive effect of the device on the woman's quality of life was demonstrated.
  
  
  CONCLUSIONS
  The slow-release levonorgestrel intrauterine device may be a valid therapeutic tool for treating basic symptomatology and increasing quality of life in women with abnormal uterine bleeding.
authors.affiliation: Department of Gynecology, Obstetrics and Pathophysiology of Human Reproduction, University of Messina, Messina, Italy. vipalmara@unime.it
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmara
authors.forename: Emanuele
authors.initials: E
authors.lastname: Sturlese
authors.forename: Daniela
authors.initials: D
authors.lastname: Villari
authors.forename: Valentina
authors.initials: V
authors.lastname: Giacobbe
authors.forename: Annalisa
authors.initials: A
authors.lastname: Retto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santoro
mesh_terms: D000328:Adult; D004714:Endometrial Hyperplasia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008796:Metrorrhagia / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D011788:Quality of Life; D014463:Ultrasonography
chemical_list: D016912:Levonorgestrel
keywords: abnormal uterine bleeding; endometrial epithelium; endometrial hyperplasia; levonorgestrel-releasing intrauterine system