Mirena: a novel alternative to hysterectomy
Keywords:Abnormal uterine bleeding, Endometrial hyperplasia, Levonorgestrel intrauterine system, Mirena
Background: To study the awareness and efficacy of Mirena (Levonorgestrel intrauterine system) in treatment of abnormal uterine bleeding.
Methods: A prospective analytical study was conducted from January 2012 to June 2018 at Smt. Kashibai Navale medical college and general hospital, Pune, Maharashtra, India. Total 30 women between age of 35 to 45 yrs age were included in the study. Mirena was inserted post-menstrually in the operation room under sedation was done. The women were called for follow-up after 1 month, then 4 months, and then yearly (for maximum 2 years); and asked regarding the relief they have obtained from the antecedent menstrual complaints.
Results: At end of study, Overall satisfaction rate among women was 76.67% and decrease menstrual blood flow observed in 20 (74.07%) cases. Most common side effect observed was irregular menses in 6 (22.22%) cases. Hysterectomy was required in 3 (11.11%) cases.
Conclusions: Menorrhagia is a common gynaecologic problem often needing hysterectomy. The LNG-IUS reduces bleeding in women with menorrhagia due to benign causes. The patient acceptance and satisfaction is high. Main problem is irregular bleeding especially for the first 3 months after insertion. If the patients can be counseled before insertion, continuation rates for LNG-IUS are high. It has the potential to replace hysterectomy as treatment of choice in certain patients.
Lethaby A, Hussain M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;(4):CD002126.
Fraser IS, Langham S, Uhl-Hochgraeber K. Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol. 2009;4:179-89.
Sharma A, Dogra Y. Trends of AUB in tertiary centre of Shimla hills. J Midlife Health. 2013;4:67-8.
Wright RC. Hysterectomy: past, present, and future. Obstet Gynecol. 1969;33:560-3.
Andersson K, Odlind V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. Contraception. 1994;49(1):56-72.
Seeber B, Ziehr SC, Gschliesser A, Moser C, Mattle V, Seger C, et al. Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system. Contraception. 2012;86:345.
Guttinger A, Critchley HO. Endometrial effects of intrauterine levonorgestrel. Contraception. 2007;75:S93-S8.
Endrikat J, Shapiro H, Lukkari-Lax E, Kunz M, Schmidt W, Fortier M. A Canadian, multicentre study comparing the efficacy of a levonorgestrel-releasing intrauterine system to an oral contraceptive in women with idiopathic menorrhagia. J Obstet Gynaecol Can. 2009;31:340-7.
Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkilä A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol. 1998;105:592-8.
National Institute for Health and Clinical Excellence. Heavy menstrual bleeding. NICE clinical guideline 44 (NICE, London). 2007.
Dhamangaonkar PC, Anuradha K. Levonorgestrel intrauterine system (Mirena): An emerging tool for conservative treatment of abnormal uterine bleeding. J Midlife Health. 2015;6(1):26-30.
Heikinheimo O, Gemzell-Danielsson K. Emerging indications for the levonorgestrel-releasing intrauterine system (LNG-IUS). Acta Obstet Gynecol Scand. 2012;91(1):3-9.
Kim ML, Seong SJ. Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases. Obstet Gynecol Sci. 2013;56(2):67-75.
Vasudeva S, Malhotra G, Gulati SK, Chandel YS. Mirena and nuvaring in management in dysfunctional uterine bleeding. Int J Conte Med Res. 2018;5(4):D5-D9.
Ozdegirmenci O, Kayikcioglu F, Akgul MA, Kaplan M, Karcaaltincaba M, Haberal A, et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril. 2011;95:497-502.