title: Different bleeding patterns with the use of levonorgestrel intrauterine system: are they associated with changes in uterine artery blood flow?
abstract: OBJECTIVE
  Evaluate if different bleeding patterns associated with the use of the levonorgestrel intrauterine system (LNG-IUS) are associated with different uterine and endometrial vascularization patterns, as evidenced by ultrasound power Doppler analysis.
  
  
  METHODS
  A longitudinal study, with each subject acting as its own control was conducted between January 2010 and December 2012. Healthy volunteers with a history of heavy but cyclic and regular menstrual cycles were enrolled in the study. Ultrasonographic examination was performed before and after six months of LNG-IUS placement: uterine volume, endometrial thickness, and subendometrial and myometrial Doppler blood flow patterns have been evaluated.
  
  
  RESULTS
  A total of 32 women were enrolled out of 186 initially screened. At six months of follow-up, all subjects showed a reduction in menstrual blood loss; for analysis, they were retrospectively divided into 3 groups: normal cycling women (Group I), amenorrheic women (Group II), and women with prolonged bleedings (Group III). Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI) and resistance index (RI) in the spiral arteries were significantly lower in Group I and Group III compared to Group II. This difference persisted also when comparing--within subjects of Group III--mean PI and RI mean values before and after insertion.
  
  
  CONCLUSIONS
  The LNG-IUS not only altered endometrial thickness, but--in women with prolonged bleedings--also significantly changed uterine artery blood flow. Further studies are needed to confirm these results and enable gynecologists to properly counsel women, improving initial continuation rates.
authors.affiliation: Department of Gynaecology, Obstetrics, and Urology, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bastianelli
authors.affiliation: Department of Gynaecology, Obstetrics, and Urology, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy ; C/O Associazione Italiana Educazione Demografica (AIED), Via Toscana 30, 00187 Rome, Italy.
authors.forename: Manuela
authors.identifier: 0000-0001-5979-4413
authors.initials: M
authors.lastname: Farris
authors.affiliation: Department of Gynaecology, Obstetrics, and Urology, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy ; C/O Associazione Italiana Educazione Demografica (AIED), Via Toscana 30, 00187 Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rapiti
authors.affiliation: Department of Gynaecology, Obstetrics, and Urology, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Roberta Bruno
authors.initials: RB
authors.lastname: Vecchio
authors.affiliation: Department of Gynaecology, Obstetrics, and Urology, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Benagiano
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D004717:Endometrium / Q000000981:diagnostic imaging; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008595:Menorrhagia / Q000188:drug therapy*; D008598:Menstruation / Q000187:drug effects; D008875:Middle Aged; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000187:drug effects*; D014599:Uterus / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D016912:Levonorgestrel