Please wait a minute...
浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (2): 130-135    DOI: 10.3785/j.issn.1008-9292.2019.04.02
    
Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis
ZHANG Lifeng1(),YANG Hui2,ZHANG Xinmei1,CHEN Zhengyun1,*()
1. Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
2. Hunan Maternal and Child Health Hospital, Changsha 410008, China
Download: HTML( 19 )   PDF(914KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To evaluate the efficacy and adverse effects of levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods: The clinical data of 75 patients with adenomyosis who had Mirena insertion in Women's Hospital, Zhejiang University School of Medicine from September 2013 to December 2013 were retrospectively analyzed. The patients were followed up to 39 months. The efficacy and adverse effects were assessed. Results: Pictorial Blood Loss Assessment Chart (PBAC) scores were decreased significantly after Mirena insertion both in patients with menorrhea (118±13 vs. 29±33, P < 0.01) and normal menstruation (82±15 vs. 14±13, P < 0.01); the patients with menorrhea showed a more significant decrease in PBAC score than those with normal menstruation (90±35 vs. 69±19, P < 0.01). The visual analogue scale (VAS) score decreased significantly after Mirena insertion compared with pre-treatment[7(6, 7) vs. 1(0, 2), P < 0.01]. The expulsion of Mirena occurred in 18 cases (24.0%); 9 cases (12.0%) had no effect and 28 cases (37.3%) had changes of menstruation patterns. Multivariate Cox regression analysis showed that the expulsion of Mirena was not associated with post-treatment VAS score, PBAC score before and after treatment or menstrual stabilization time (all P>0.05). Conclusion: Mirena is effective and safe in the long term management of adenomyosis, but about one third patients may require further treatment because of the expulsion or ineffectiveness of Mirena.

Key words： Adenomyosis/drug therapy      Intrauterine devices, medicated/adverse effects      Levonorgestrel/therapeutic use      Treatment outcome     
Received: 26 January 2019      Published: 24 July 2019
CLC:  R711.74  
Corresponding Authors: CHEN Zhengyun     E-mail: lfzhang1993@163.com;5504004@zju.edu.cn
Service
E-mail this article
Add to my bookshelf
Add to citation manager
E-mail Alert
RSS
Articles by authors
ZHANG Lifeng
YANG Hui
ZHANG Xinmei
CHEN Zhengyun
Cite this article:

ZHANG Lifeng,YANG Hui,ZHANG Xinmei,CHEN Zhengyun. Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis. J Zhejiang Univ (Med Sci), 2019, 48(2): 130-135.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.04.02     OR     http://www.zjujournals.com/med/Y2019/V48/I2/130


左炔诺孕酮宫内节育系统治疗子宫腺肌病患者的疗效和不良反应观察

目的: 探讨左炔诺孕酮宫内节育系统（曼月乐）治疗子宫腺肌病的疗效和不良反应。方法: 回顾性分析2013年9至12月于浙江大学医学院附属妇产科医院因子宫腺肌病就诊并放置曼月乐的患者75例，共随访39个月，观察曼月乐的疗效和不良反应。结果: 月经量增多和月经量正常的患者放置曼月乐后月经量评分均降低（118±13和29±33，82±15和14±13，均P < 0.01），月经量增多者比月经量正常者的月经量评分降低更明显（90±35和69±19，P < 0.01）。放置曼月乐后患者痛经评分降低[7（6，7）和1（0，2），P < 0.01]。患者发生曼月乐脱落18例（24.0%），放置曼月乐无效9例（12.0%），发生月经模式改变28例（37.3%）。多因素Cox回归分析未发现治疗后痛经评分、治疗前后月经量评分和月经稳定时间与曼月乐环脱落相关（均P>0.05）。结论: 曼月乐在子宫腺肌病的长期保守治疗中总体安全有效，约1/3的患者可能因曼月乐脱落或治疗无效接受进一步治疗。


关键词： 子宫腺肌病/药物疗法,  宫内避孕器, 含药/副作用,  左炔诺孕酮/治疗应用,  治疗结果 
[$\bar x \pm s$或M(Q1，Q3)或n(%)]
变量 曼月乐未脱落 曼月乐脱落 统计量 P值
年龄(岁) 40.2±5.0 40.1±5.0 0.0886 ＞0.05
治疗前痛经评分 7(6, 7) 6(5, 7) 1.6158 ＞0.05
治疗后痛经评分 1(0, 2) 2(1, 5) 2.3005 ＜0.05
治疗前月经量评分 8.9211 ＜0.01
  ≤100 29(93.55) 2(6.45)
  >100 28(63.64) 16(36.36)
治疗后月经量评分 10.2073 ＜0.01
  ≤100 54(81.82) 12(18.46)
  >100 3(33.33) 6(60.00)
止痛起效时间 0.0078 ＞0.05
  ≤3个月 48(76.19) 15(23.81)
  >3个月 9(75.00) 3(25.00)
月经稳定时间 4.8336 ＜0.05
  ≤3个月 26(89.66) 3(10.34)
  >3个月 31(67.39) 15(32.61)
Tab 1 Univariate analysis of Mirena expulsion
变量 HR(95% CI) P值
“—”无相关数据.
治疗后疼痛评分 1.06(0.86~1.30) ＞0.05
治疗前经量评分   ≤100 1.00 —
                 >100 3.84(0.81~18.27) ＞0.05
治疗后经量评分  ≤100 1.00 —
                 >100 3.54(0.91~13.69) ＞0.05
月经稳定时间   ≤3个月 1.00 —
                 >3个月 1.95(0.50~7.63) 0.50
Tab 2 Multivariate Cox regression analysis of Mirena expulsion
[1]   EXACOUSTOS C , ZUPI E . A new era in diagnosing adenomyosis is coming[J]. Fertil Steril, 2018, 110 (5): 858
doi: 10.1016/j.fertnstert.2018.07.005
[2]   PARK D S , KIM M L , SONG T et al. Clinical experiences of the levonorgestrel-releasing intrauterine system in patients with large symptomatic adenomyosis[J]. Taiwan J Obstet Gynecol, 2015, 54 (4): 412- 415
doi: 10.1016/j.tjog.2014.05.009
[3]   OZDEGIRMENCI O , KAYIKCIOGLU F , AKGUL M A et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis[J]. Fertil Steril, 2011, 95 (2): 497- 502
doi: 10.1016/j.fertnstert.2010.10.009
[4]   SPENCER J C, LOUIE M, MOULDER J K, et al. Cost-effectiveness of treatments for heavy menstrual bleeding[J/OL]. Am J Obstet Gynecol, 2017, 217(5): 574.e1-574.e9.
[5]   YOUM J , LEE H J , KIM S K et al. Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system[J]. Int J Gynaecol Obstet, 2014, 126 (2): 165- 169
doi: 10.1016/j.ijgo.2014.02.017
[6]   KIM M K , CHON S J , LEE J H et al. Postoperative levonorgestrel-releasing intrauterine system insertion after gonadotropin-releasing hormone agonist treatment for preventing endometriotic cyst recurrence:a prospective observational study[J]. Reprod Sci, 2018, 25 (1): 39- 43
doi: 10.1177/1933719117718274
[7]   冯力民, 夏恩兰, 黄晓武 et al. 应用月经失血图评估月经血量[J]. 中华妇产科杂志, 2001, 36 (1): 51
FENG Limin , XIA Enlan , HUANG Xiaowu et al. Application of pitorial blood loss assessment[J]. Chinese Journal of Obstetrics and Gynecology, 2001, 36 (1): 51
doi: 10.3760/j.issn:0529-567X.2001.01.019
[8]   中华医学会妇产科学分会子宫内膜异位症协作组 . 子宫内膜异位症的诊治指南[J]. 中华妇产科杂志, 2015, 50 (3): 161- 169
Collaborative Group of Adenomyosis, Society of Obstetrics and Gynecology, Chinese Medical Association . Guideline for diagnosis and treatment of adenomyosis[J]. Journal of Obstetrics and Gynecology, 2015, 50 (3): 161- 169
doi: 10.3760/cma.j.issn.0529-567x.2015.03.001
[9]   CHOI Y S , CHO S , LIM K J et al. Effects of LNG-IUS on nerve growth factor and its receptors expression in patients with adenomyosis[J]. Growth Factors, 2010, 28 (6): 452- 460
doi: 10.3109/08977194.2010.511619
[10]   李雷, 冷金花, 史精华 et al. LNG-IUS治疗子宫腺肌病相关经量过多的前瞻性研究[J]. 中华妇产科杂志, 2016, 51 (6): 424- 430
LI Lei , LENG Jinhua , SHI Jinghua et al. A prospective study on the effects of levonorgestrel-releasing intrauterine system for adenomyosis with menorrhagia[J]. Journal of Obstetrics and Gynecology, 2016, 51 (6): 424- 430
doi: 10.3760/cma.j.issn.0529-567x.2016.06.005
[11]   SHAABAN O M , ALI M K , SABRA A M et al. Levonorgestrel-releasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri:a randomized clinical trial[J]. Contraception, 2015, 92 (4): 301- 307
doi: 10.1016/j.contraception.2015.05.015
[12]   MAWET M , NOLLEVAUX F , NIZET D et al. Impact of a new levonorgestrel intrauterine system, Levosert(?), on heavy menstrual bleeding:results of a one-year randomised controlled trial[J]. Eur J Contracept Reprod Health Care, 2014, 19 (3): 169- 179
doi: 10.3109/13625187.2014.894184
[13]   CHO S, NAM A, KIM H, et al. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis[J/OL]. Am J Obstet Gynecol, 2008, 198(4): 373.e1-7.
[14]   SHENG J , ZHANG W Y , ZHANG J P et al. The LNG-IUS study on adenomyosis:a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis[J]. Contraception, 2009, 79 (3): 189- 193
doi: 10.1016/j.contraception.2008.11.004
[15]   李雷, 冷金花, 张俊吉 et al. LNG-IUS治疗症状性子宫腺肌病过程中月经模式的改变与不良反应[J]. 中华妇产科杂志, 2016, 51 (9): 657- 662
LI Lei , LENG Jinhua , ZHANG Junji et al. Changes of menstruation patterns and adverse effects during the treatment of LNG-IUS for symptomatic adenomyosis[J]. Journal of Obstetrics and Gynecology, 2016, 51 (9): 657- 662
doi: 10.3760/cma.j.issn.0529-567x.2016.09.004
[16]   ONTARIO H Q . Levonorgestrel-releasing intrauterine system (52 mg) for idiopathic heavy menstrual bleeding:a health technology assessment[J]. Ont Health Technol Assess Ser, 2016, 16 (18): 1- 119
[17]   ZHANG P , SONG K , LI L et al. Efficacy of combined levonorgestrel-releasing intrauterine system with gonadotropin-releasing hormone analog for the treatment of adenomyosis[J]. Med Princ Pract, 2013, 22 (5): 480- 483
doi: 10.1159/000351431
[18]   李雷, 冷金花, 贾双征 et al. 左炔诺孕酮宫内缓释系统治疗子宫腺肌病计划外取出和脱落情况及其相关因素分析[J]. 中国实用妇科与产科杂志, 2016, 32 (11): 1088- 1092
LI Lei , LENG Jinhua , JIA Shuangzheng et al. Analysis of unplanned taking-out and expulsion of LNG-IUS and related factors during the treatment of symptomatic adenomyosis[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2016, 32 (11): 1088- 1092
[19]   LEE K H , KIM J K , LEE M A et al. Relationship between uterine volume and discontinuation of treatment with levonorgestrel-releasing intrauterine devices in patients with adenomyosis[J]. Arch Gynecol Obstet, 2016, 294 (3): 561- 566
doi: 10.1007/s00404-016-4105-y
[20]   RADZINSKY V E , KHAMOSHINA M B , NOSENKO E N et al. Treatment strategies for pelvic pain associated with adenomyosis[J]. Gynecol Endocrinol, 2016, 32 (sup2): 19- 11
doi: 10.1080/09513590.2016.1232673
[21]   张信美, 许泓, 黄秀峰 et al. 左炔诺孕酮宫内缓释系统治疗子宫腺肌病的长期疗效观察[J]. 中华妇产科杂志, 2009, 44 (9): 694- 696
ZHANG Xinmei , XU Hong , HUANG Xiufeng et al. Long term efficacy of levonorgestrel releasing intrauterine system in treatment of adenomyosis[J]. Journal of Obstetrics and Gynecology, 2009, 44 (9): 694- 696
doi: 10.3760/cma.j.issn.0529-567x.2009.09.016
[1] LOU Junyao,HUANG Xiufeng,ZHANG Lifeng,XU Ping,ZHANG Xinmei,CHEN Zhengyun. The second generation endometrial ablation (NovaSure) improves efficacy of levonorgestrel-releasing intrauterine system in management of adenomyosis[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 136-141.
[2] ZHANG Xinmei,XU Ping. Stratified treatment and management of adenomyosis[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 123-129.
[3] SHEN Hong,JI Feng. Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.
[4] YIN Xiaoliang,LANG Dehai,WANG Di. Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.
[5] LIN Zuodong,LANG Dehai. Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 595-600.
[6] WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun. Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.
[7] YU Zuanbiao,LIN Zuodong,LANG Dehai. Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 623-627.
[8] DENG Xuan,HE Hanqing,ZHOU Yang,PAN Jinren,YAN Rui,TANG Xuewen,FU Jian. Economic evaluation of different chickenpox vaccination strategies[J]. J Zhejiang Univ (Med Sci), 2018, 47(4): 374-380.
[9] XU Weize,YE Jingjing,LI Jianhua,ZHANG Zewei,YU Jiangen,SHI Zhuo,YU Jin,SHU Qiang. Efficacy of percutaneous atrial septal defect closure guided by transesophageal echocardiography in children[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 244-249.
[10] ZHANG Yuxi,MO Xuming,SUN Jian,PENG Wei,QI Jirong,WU Kaihong,SU Yaqin. Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 266-271.
[11] ZHANG Shisong,WU Yurui,LIU Hongzhen,ZHAI Yunpeng,LIU Wei. Experience in treatment of complex congenital intestinal atresia in children[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 255-260.
[12] LYU Chengjie,HU Donglai,HUANG Shoujiang,QIN Qi,ZHAO Xiaoxia,HU Shuqi,ZHANG Yanan,FANG Xuan,GUO Xiaodong,TOU Jinfa. Transumbilical single-site laparoscopic surgery for congenital duodenal obstruction in neonates[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 261-265.
[13] ZHU Ziyi,LI Zhijun,HE Zhengfu,WANG Yunzhen. Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 637-642.
[14] LU Wei,LIN Mengna,ZHAO Shifang,WANG Huiming,HE Fuming. Application of modified lateral window for maxillary sinus floor augmentation[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 630-636.
[15] ZHANG Siying, CHEN Feng. Research progress of CT/MRI parametric response map in precision evaluation of therapeutic response of cancer patients[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 468-472.