Managing dub with progesterone - locally or orally which is a better option?
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20161309Keywords:
LNG-IUS, DUB, Hb, PBAC ScoresAbstract
Background: The levonorgestrel intrauterine system (LNG-IUS) is a safe and effective form of contraception used by millions of people worldwide. Other than this, it has many non-contraceptive benefits-treatments for dysfunctional uterine bleeding (DUB), fibroid uterus, endometriosis and endometrial hyperplasia.
Methods: A prospective longitudinal comparative study was carried out at department of obstetrics and gynaecology S.N. Medical College, Agra, Uttar Pradesh, India including 100 women of 20-45 years of age group (comparable in all aspects), with DUB. All cases were subjected to detailed history, examination and baseline investigations- Hemoglobin (Hb), endometrial aspiration, histopathology and ultrasound pelvis (along with endometrial thickness) and PBAC scoring before starting the treatment. Then cases were randomly allocated in two equal groups. In group A LNG-IUS was inserted. In group B cases were prescribed oral medroxy progesterone acetate 10 mg bd from 5th and 25th day of menstrual cycle. Cases were followed at 1 month, 3 months and 6 months after starting treatment. At each follow-up visit primary outcome in terms of subjective assessment by patient, PBAC scores and secondary outcome as Hb levels and side-effects were recorded.
Results: Reduction in PBAC Scores, improvement in Hb and reduction in endometrial thickness were seen with both treatment modalities but results were significantly (p <0.0001) better with LNG-IUS group as compared to MPA. LNG-IUS was found to be more effective in endometrial hyperplasia and proliferative type of endometrium.
Conclusions: LNG-IUS is a good alternative to oral progesterone therapy for patients of DUB.
References
Palep Singh, Prentice A. Epidemiology of abnormal uterine bleeding. Best practice and research clinical obstetrics and gynaecology. 2007;21(6):887-90.
Ann LM, Jay Mc G. Menstruation and menstrual disorder. In: Wshaw R, Soutter WP, Stuart L. Stauton Gynaecology 3rd ed. UK, Churchill Livingston; 2003:459-473.
Behera MA. Dysfunctional uteine bleeding. Richard Scott Lucidi Practice essentials, emedicine. medscape. com/article/ 257007-ov
Coutler A, Kelland J, Peto V, Rees MC. Treating menorrhagia in primary care. An overview of drug trials and a survey of prescribing practice. Int J Tech Assess Health Care. 1995;11:456-71.
Winsor SHM, Fisher S, Hahn PM, Reid RL. Retrospective evaluation of long term outcomes following conservative management of menorrhagia in ovulatory women. J Soc Obstet Gynaecol Can. 1999;2:155-63.
National collaborating centre for women’s and children’s health, national institute of clinical excellence. Heavy menstrual bleeding. Clinical guideline. London. RCOG Press; 2007.
Naeema U, Faheem F. LNG-IUS in menorrhagia : a three year follow up study. Journal of postgraduate medical institute. 2010;26(1):79-83.
Robert W. Symonds IM, Tamizian O, Chaplain J, Mukhopadhyay S. Randomised comparative trial of thermal balloon ablation and levonorgestrel intrauterine system in patients with idiopathic menorrhagia. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007;47(4):335-40.
Kucuk T, Ertan K. Contiuous oral or intramuscular medroxy progesterone acetate versus LNG-IUS in treatment of perimenopausal menorrhagia .clinical and experimental obstetrics and gynaecology. 2008;35(1):57-60.
Shaaban MM, Zakherah MS, El-Nashar SA, Sayed GH. Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial. Contraception. 2011;83(1):48-54.
Chattopdhyay B, Nigam A, Goswami S, Chakravarty PS. Clinical outcome of levonorgestrel intra-uterine system in idiopathic menorrhagia. Eur Rev Med Pharmacol Sci. 2011;15(7):764-8.
Kriplani A, Singh BM, Lal S, Agarwal N. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. International Journal of Gynecology and Obstetrics. (2007);97(3): 190-4.
Sajitha K, Padma SK, Shetty KJ, Kishanprasad HL, Permi HS, Hegde P. Study of histopathological patterns of endometrium in abnormal uterine bleeding. CHRISMED J Health Res. 2014;1:76-81.
Patil R, Patil RK, Andola SK, Laheru V, Bhandar M. Histopathological spectrum of endometrium in dysfuctional uterine bleeding. 2013;4(1): 2798-2801.
Taru G, Nupur G, Sangeeta G, Pushpa B, Jyoti J, Sushma K. Levonorgestrel intrauterine system (LNG IUS) in menorrahgia: a follow-up study. Open Journal of Obstetrics and Gynecology. 2014;4:190-6.
