title: Combined Endometrial Ablation and Levonorgestrel Intrauterine System Use in Women With Dysmenorrhea and Heavy Menstrual Bleeding: Novel Approach for Challenging Cases.
abstract: OBJECTIVE
  To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years.
  
  
  METHODS
  Cohort study (Canadian Task Force II-2).
  
  
  METHODS
  An academic institution in the upper Midwest.
  
  
  METHODS
  All women with HMB and dysmenorrhea who underwent EA with combined placement of LNG-IUS (EA/LNG-IUS cohort, 23 women) after 2005 and an historic reference group from women who had EA alone (EA cohort, 65 women) from 1998 through the end of 2005.
  
  
  METHODS
  Radiofrequency EA, thermal balloon ablation, and LNG-IUS.
  
  
  RESULTS
  The primary outcome was treatment failure defined as persistent pain, bleeding, and hysterectomy after EA at 4 years. The combined treatment failure outcome was documented in 2 patients (8.7%) in the EA/LNG-IUS group and 19 patients (29.2%) in the EA group with an unadjusted OR of .23 (95% CI, .05-1.08). After adjusting for known risk factors of failure, the adjusted OR was .19 (95% CI, .26-.88). None of the women who underwent EA/LNG-IUS had hysterectomy for treatment failure compared with 16 (24%) in the EA group (p = .009); postablation pelvic pain was documented in 1 woman (4.3%) in the EA/LNG-IUS group compared with 8 women (12.3%) in the EA group (p = .24). One woman in the EA/LNG-IUS group (4.3%) presented with persistent bleeding compared with 15 (23.1%) in the EA group (p = .059). Office removal of the intrauterine device was performed in 4 women with no complications.
  
  
  CONCLUSIONS
  LNG-IUS insertion at the time of EA is feasible and can provide added benefit after EA in women with dysmenorrhea and HMB.
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Efstathios P
authors.initials: EP
authors.lastname: Papadakis
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Laughlin-Tommaso
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sherif A M
authors.initials: SA
authors.lastname: Shazly
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Breitkopf
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Electronic address: famuyide.abimbola@mayo.edu.
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use*; D004412:Dysmenorrhea / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D055356:Endometrial Ablation Techniques / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D008595:Menorrhagia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D003280:Contraceptives, Oral, Synthetic; D016912:Levonorgestrel
keywords: Dysmenorrhea; Endometrial ablation (EA); Heavy menstrual bleeding (HMB); Levonorgestrel intrauterine system (LNG-IUS)