Perforation of levonorgestrel-releasing intrauterine system found at one month after insertion:A case report

BACKGROUND The levonorgestrel-releasing intrauterine system(LNG-IUS)is widely used in contraception,menorrhagia,dysmenorrhea and to prevent endometrial hyperplasia during estrogen supplementation.Perforation is more often seen after early postpartum placement.Perforation of the LNG-IUS occurring one month after placement is rare.CASE SUMMARY A 42-year-old female complained of progressive dysmenorrhea and increased menstrual volume.She was diagnosed with adenomyosis and the LNG-IUS was inserted in her uterine cavity.Routine ultrasound examination one month later revealed that the intra-uterine device(IUD)was not found in the uterine cavity,and further X-ray and pelvic magnetic resonance imaging showed an abnormal signal area in the left posterior region of the uterus.Laparoscopic exploratory surgery was performed and the LNG-IUS was found in the left uterosacral ligament.CONCLUSION Perforation of a LNG-IUS occurring one month after placement is rare,and is more common in inexperienced operators and after early postpartum placement.When the operation is difficult,ultrasound monitoring is recommended to reduce the risk of IUD perforation.For patients with inadequate surgery,postoperative imaging is recommended to detect potential risks as soon as possible.

Quality of Life in Women with Endometriosis Pelvic Pain Treated with the Levonorgestrel-Releasing Intrauterine System

Objective: To evaluate the quality of life in patients with endometriosis pelvic pain before and after the application of the levonorgestrel-releasing intrauterine system (LNG-IUS). Design: Open non-comparative study. Setting: Obstetrics and Gynecology Hospital at Monterrey, Mexico. Sample: 29 women aged 18 to 40 years with pelvic pain associated with endometriosis confirmed by laparoscopy. Methods: After laparoscopy but before LNG-IUS insertion (basal visit) and 6 months afterwards, modified Endometriosis Health Profile (EHP-30) was applied. Main outcomes measures: Size of change of questionnaire scores, need of additional analgesic therapy and adverse effects. Statistical Analysis: Differences in the questionnaire scores before and after intervention were analyzed by Student t-test. Results: Final analysis set included 29 women aged 31.7 ± 4.7 years years. The ASRM surgical staging of endometriosis was mild in 19.3 moderate in 13.7 and severe in 76% of the patients. The general perception of quality of life improved from 52 at baseline to 98% at six months (p < 0.001). Adverse events were mild in nature, 19 patients reported no adverse events during the study (65.5%). Two patients (6.9%) required the use of concomitant therapy with non-steroidal analgesics for relief of pain. Conclusion: The application of LNG-IUS in patients with pelvic pain associated with endometriosis improved significatively all aspects related with quality of life as measured with Endometriosis Health Profile (EHP-30). We concluded that LNGIUS may be an effective and convenient therapeutic alternative for the management of pain associated with endometriosis.

Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system:A case report

BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.

Clinical Efficacy of Dienogest and Levonorgestrel-Releasing Intrauterine System in the Treatment of Adenomyosis

Objective:To compare the clinical efficacy and adverse reactions of dienogest and levonorgestrel-releasing intrauterine system in the treatment of adenomyosis.Methods:A total of 60 cases of adenomyosis admitted to Dezhou Women and Children’s Hospital from January 2020 to October 2021 were selected and randomly divided into two groups(Group A and Group B),which were initiated on dienogest and levonorgestrel-releasing intrauterine system,respectively.The therapeutic effects and adverse reactions of the two groups were analyzed.Results:After 6 months of treatment,the uterine volume in the LNG-IUS group reduced slightly compared with that before treatment,with no statistical significance(p>0.05),while that in the DNG group increased slightly compared with that before treatment,with no statistical significance(p>0.05).After 6 months of treatment,the hemoglobin of patients in both groups increased compared with that before treatment;there was no significant difference in the DNG group(p>0.05),but there was significant difference in the LNG-IUS group(p<0.01).After 6 months of treatment,the VAS scores of the two groups were significantly lower than those before treatment(p<0.01);the serum CA125 level in both groups decreased significantly compared with that before treatment(p<0.01).Conclusion:Mirena(levonorgestrel-releasing intrauterine system)has better therapeutic effect on adenomyosis and fewer adverse reactions than deinogest.

A comparative, randomized study of levonorgestrel Intrauterine System (LNG-IUS) vs Copper T 380 A intrauterine device applied during cesarean section

Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a primary reference hospital at Puebla City, Mexico. Sample: 396 women requiring CS signed informed consent and were randomly allocated to the post-placental application of LNG-IUS (198) or Copper T 380 A (198). Methods: Follow up visits at 6 weeks, and 6 and 12 months were performed. Main Outcomes Measures: IUDs expulsion, maternal and babies’ health conditions, breastfeeding and menstrual patterns, adverse effects and pregnancies. Differences between groups were analyzed by Fisher and X2 tests, Odds ratios, relative risk and 95% confidence limits, as appropriate. Results: After one year of follow up, no pregnancies were reported. The IUD expulsion rate was 4.5% in each group. LNG-IUS users had a higher incidence of amenorrhea (OR 2.5 95% CI 2.2 - 3) and menstrual patterns significantly brief and lighter than Copper T 380 A (p < 0.001) with lower incidence of dysmenorrhea (OR 0.1 95% CI 0.04 - 0.2). No detrimental effects of LNG-IUS on breastfeeding was observed and interestingly babies weights of LNG-IUS users was slightly above the average for age compared with Copper T 380 A users. This was probably related with a major proportion of women with normal ferritin serum levels (94% vs 68%) leading to better mother’s general condition. Conclusions: LNG-IUS inserted during CS provides high efficacy contraception with additional benefits, mainly reducing menstrual bleeding and doing so, faster recovery of ferrous homeostasis after CS.

Profile of the levonorgestrel-releasing intrauterine system users in China

The widespread usage of modem contraceptive methods has predominantly been driven by government family planning policies in efforts to mandate reduced total fertility rates.1 In particular,the high prevalence of long-acting contraception usage can be attributed to the mandatory requirement in the early 1980s for women with one child to have a copper intrauterine device （IUD） fitted and for sterilization for those with two or more children,2and more recently through financial incentives for married couples to use long-acting contraceptive methods.1 The levonorgestrel-releasing intrauterine system （LNG-IUS） has been available in China since 2000 for contraception and treatment of heavy menstrual bleeding.Little is known about the profile of the Chinese women opting to use the LNG-IUS and the type of information they received before intrauterine system placement.We undertook this survey to profile the Chinese women choosing to use the LNG-IUS in clinical practice.

左炔诺孕酮宫内缓释系统和口服避孕药预防子宫内膜息肉术后复发的临床疗效比较

目的比较左炔诺孕酮宫内缓释系统（LNG-IUS）和121服避孕药预防子宫内膜息肉术后复发的临床疗效。方法选取2010年1月至2014年12月哈尔滨市第一医院收治的160例子宫内膜息肉手术切除患者，完全随机分为观察组与对照组，各80例。所有患者均行宫腔镜息肉电切除术，观察组术后月经来潮第3天放置LNG—IUS，对照组术后月经来潮第1天开始口服复方短效避孕药（炔雌醇30ug＋屈螺酮3mg），连服21d，周期服用，连续12个月经周期。术后3、6、12个月进行随访，比较2组患者子宫内膜息肉复发率、子宫内膜厚度、血红蛋白含量、月经情况（月经失血图评分）及不良反应发生情况。结果随访12个月后，观察组子宫内膜息肉复发率明显低于对照组[2．5％（2／80）比10．0％（8／80）]，差异有统计学意义（P〈0．05）。术前2组子宫内膜厚度比较，差异无统计学意义（P〉0．05）。术后3、6、12个月，观察组子宫内膜厚度均明显低于对照组[（0．48±0．12）cm比（0．58±0．08）em，（0．68±0．42）cm比（0．99±0．12）em，（0．784-0．12）em比（1．02±0．16）cm]，差异均有统计学意义（均P〈0．05）。2组患者术前血红蛋白水平及月经失血图评分比较，差异无统计学意义（P〉0．05），随访6个月后，2组患者血红蛋白水平均明显高于术前[对照组：（106±10）g／L比（97±5）g／L，观察组：（124±16）g／L比（97±5）g/L]，月经失血图评分均明显低于术前[对照组：（64±12）分比（125±21）分，观察组：（454-11）分比（123±22）分]，且观察组血红蛋白水平明显高于对照组，月经失血图评分明显低于对照组，差异均有统计学意义（均P〈0．05）。随访3个月时，观察组阴道点滴出血发生率明显高于对照组[50．0％（40／80）比20．O％（16／80）]，差异有统计学意义（P〈0．05）。随访12个月后，观察组与对照组阴道点滴出血发生率比较[6．2％（5／80）比7．5％（6／80）]，差异无统计学意义（P〉0．05）。对11例阴道点滴出血患者进行宫腔镜检查，子宫内膜均无异常。观察组未出现头晕、恶心、胃部不适等不良反应，对照组术后3个月出现头晕3例，恶心7例，12个月随访出现胃部不适2例。结论LNG．IUS在预防宫腔镜息肉电切除术后复发、降低子宫内膜增生厚度、改善月经情况和血红蛋白水平等方面，均优于口服避孕药，且不良反应少，创伤小。