ACMJ

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

EndNote Style
Index
Original Article
Patient satisfaction, sexual function and decision regret in use of levonorgestrel releasing intrauterine device
Aims: Abnormal uterine bleeding is a common condition. The etiological cause and treatments are diverse. Levonorgestrel intrauterin device (LNG-IUD) can be used to treat abnormal uterine bleeding. It has been shown to reduce the amount of bleeding in patients with menorrhagia and increase hemoglobin (Hb) and hematocrit (Hct) values. The aim is to investigate the effects of LNG-IUD on Hb, Hct, bleeding pattern, and its effect on sexual function, decision regret, and menorrhagia effects according to the etiologic cause. Material and
Methods: Our study included patients who underwent LNG-IUD implantation and had been using it for over six months. Patients with a history of postmenopausal or adolescent bleeding, hematologic or oncologic diseases, and a history of drug use that may cause coagulation disorders were excluded. Patients were grouped according to their indications as polyp (n=26), adenomyosis (n=16), leiomyoma (n=27), hyperplasia (n=18), and non-structural causes (n=81). Hb and Hct values were examined before and after the application, and bleeding patterns were questioned. Participants were administered Menorrhagia Impact Questionnaire (MIQ), Arizona Sexual Experience Scale and Decision Regret Scale.
Results: 168 patients were included in our study. The average duration of LNG-IUD use was 627.0±319 days and the average age was 43.4±6.1 years. The frequency of bleeding (number of bleedings per year) was 18.0±8.0 before LNG-IUD application and 7.8±8.0 after treatment (p<0.001), and bleeding duration was 11.5±9.5 days before application and 4.8±6.2 days after application (p<0.001). The number of pads used per day was 7.7±3.9 before the application and 1.1±1.4 after the application (p<0.001). While the average Hb value was 11.2±2.0 and Hct value was 34.8±5.1 (n=112) before LNG-IUD application, the average hemogram value was 12.9±1.6 and Hct value was 39.3±4.1 (n=66) after application and a statistically significant increase was observed in Hb and Hct values (p<0.01). When the groups were compared according to the indication, there was no significant difference in the average number of days of LNG-IUD use, total Arizona score, number of individuals with sexual dysfunction according to the Arizano score and decision regret score.
Conclusion: LNG-IUD in treating patients with abnormal uterine bleeding increases Hb and Hct values and decreases the bleeding frequency, duration, and daily pad use. LNG-IUD use did not make a difference in sexual functions and decision regret according to the etiologic cause.


1. Liu Z, Doan Q, Blumenthal P, Dubois RW. A systematic reviewevaluating health-related quality of life, work impairment, andhealth-care costs and utilization in abnormal uterine bleeding.Value Health 2007; 10: 183-94.
2. Fraser IS, Critchley HOD, Broder M, Munro MG. The FIGOrecommendations on terminologies and definitions for normaland abnormal uterine bleeding. Semin Reprod Med 2011; 29:383-90.
3. Heavy menstrual bleeding: assessment and management.National Institute for Health and Care Excellence (NICE),Clinical Guidelines Vol. 29, 2018, London.
4. Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, DeSanctisY, Jensen J. Levonorgestrel-Releasing Intrauterine System forheavy menstrual bleeding improves hemoglobin and ferritinlevels. Contraception 2012; 86: 452-457.
5. Munro MG, Critchley HOD, Broder MS, Fraser IS, FIGOWorking Group on Menstrual Disorders. FIGO classificationsystem (PALM-COEIN) for causes of abnormal uterine bleedingin nongravid women of reproductive age. Int J Gynaecol Obstet2011; 113: 3-13.
6. McGahuey CA, Gelenberg AJ, Laukes CA, et al. The Arizonasexual experience scale (ASEX): reliability and validity. J SexMarital Ther 2000; 26: 25-40
7. Soykan A. The reliability and validity of Arizona sexualexperiences scale in Turkish ESRD patients undergoinghemodialysis. Int J Impot Res 2004; 16: 531-4.
8. Bushnell DM, Martin ML, Moore KA, Richter HE, Rubin A,Patrick DL. Menorrhagia Impact Questionnaire: assessing theinfluence of heavy menstrual bleeding on quality of life. CurrMed Res Opin 2010; 26: 2745-55.
9. Brehaut JC, O&rsquo;Connor AM, Wood TJ, et al. Validation of adecision regret scale. Med Decis Making 2003; 23: 281-92.
10. Telatar T G, Satır &Ouml;zel C, Turgut A, Kınlı O. Turkish versionmethodological validation study of the Decision Regret Scale.Ethiopian J Health Development 2021; 35: 362-6.
11. Luukkainen T, Allonen H, Haukkamaa M, L&auml;hteenm&auml;ki P, NilssonCG, Toivonen J. Five years&rsquo; experience with Levonorgestrel-Releasing IUDs. Contraception 1986; 33: 139-48.
12. Xiao BL, Zhou LY, Zhang XL, Jia MC, Luukkainen T, AllonenH. Pharmacokinetic and pharmacodynamic studies oflevonorgestrel-releasing intrauterine device. Contraception1990; 41: 353-62.
13. Bahamondes L, Valeria Bahamondes M, Shulman LP. Non-contraceptive benefits of hormonal and intrauterine reversiblecontraceptive methods. Hum Reprod Update 2015; 21: 640-51.
14. Silverberg SG, Haukkamaa M, Arko H, Nilsson CG,Luukkainen T. Endometrial morphology during long-term useof levonorgestrel-releasing intrauterine devices. Int J GynecolPatholson 1986; 5: 235-41.
15. Koh SCL, Singh K. The effect of levonorgestrel-releasingıntrauterine system use on menstrual blood loss and thehemostatic, fibrinolytic/inhibitor systems in women withmenorrhagia. J Thromb Haemost 2007; 5: 133-8.
16. Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatmentof adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 1997; 68: 426-9.
17. Endrikat J, Shapiro H, Lukkari-Lax E, Kunz M, Schmidt W,Fortier M. A Canadian, multicentre study comparing the efficacyof a levonorgestrel-releasing intrauterine system to an oralcontraceptive in women with idiopathic menorrhagia. J ObstetGynaecol Can 2009; 31: 340-7.
18. Bofill Rodriguez M, Dias S, Jordan V, et al. Interventions forheavy menstrual bleeding; overview of Cochrane reviews andnetwork meta-analysis. Cochrane Database Syst Rev 2022; 5:CD013180.
19. Ozdegirmenci O, Kayikcioglu F, Akgul MA, et al. Comparisonof levonorgestrel intrauterine system versus hysterectomy onefficacy and quality of life in patients with adenomyosis. FertilSteril 2011; 95: 497-502.
20. Romero SA, Young K, Hickey M, Su HI. Levonorgestrelintrauterine system for endometrial protection in women withbreast cancer on adjuvant tamoxifen. Cochrane Database SystRev 2020; 12: CD007245.
21. Wang Y, Yang M, Huang X, Li X, Lin E, Feng Y. Prevention ofbenign endometrial polyp recurrence using a Levonorgestrel-releasing Intrauterine System in premenopausal patients: aretrospective cohort study. J Minim Invasive Gynecol 2020; 27:1281-6.
22. Kuzel D, Mara M, Zizka Z, Koliba P, Dundr P, Fanta M. Malignantendometrial polyp in woman with the levonorgestrel intrauterinesystem - a case report. Gynecol Endocrinol 2019; 35: 112-4.
23. Chowdary P, Maher P, Ma T, Newman M, Ellett L, Readman E.The role of the Mirena intrauterine device in the managementof endometrial polyps: a pilot study. J Minim Invasive Gynecol2019; 26: 1297-302.
24. Bulun SE. Uterine fibroids. N Engl J Med 2013; 369: 1344-55.
25. American College of Obstetricians and Gynecologists committeeon Prcatice Bulletins-Gynecology, Management of symptomaticuterine leiomyomas. Obstet Gynecol 2021; 137: e100-e15.
26. Senol T, Kahramanoglu I, Dogan Y, Baktiroglu M, Karateke A,Suer N. Levonorgestrel-releasing intrauterine device use as analternative to surgical therapy for uterine leiomyoma. Clin ExpObstet Gynecol 2015; 42: 224-7.
27. Chen S, Liu J, Peng S, Zheng Y. LNG-IUS vs. medical treatmentsfor women with heavy menstrual bleeding: a systematic reviewand meta-analysis. Front Med (Lausanne) 2022; 9: 948709.
28. Turan G, Bahat PY, Cetin BA, Peker N. The effect of alevonorgestrel-releasing intrauterine device on female sexualfunction. J Obstet Gynaecol (Lahore) 2021; 41: 269-74.
29. Halmesm&auml;ki K, Hurskainen R, Teperi J, et al. The effect ofhysterectomy or levonorgestrel-releasing intrauterine system onsexual functioning among women with menorrhagia: a 5-yearrandomised controlled trial. BJOG 2007; 114: 563-8.
30. Gemzell-Danielsson K, Apter D, Hauck B, et al. The effect of age,parity and body mass index on the efficacy, safety, placement anduser satisfaction associated with two low-dose LevonorgestrelIntrauterine Contraceptive Systems: subgroup analyses of datafrom a Phase III trial. PLoS One 2015; 10: e0135309.
31. Hurskainen R, Teperi J, Rissanen P, et al.Clinical outcomes andcosts with the levonorgestrel-releasing intrauterine system orhysterectomy for treatment of menorrhagia: randomized trial5-year follow-up. JAMA 2004; 291: 1456-63.
32. Blumenthal P D, Dawson L, Hurskainen R. Cost-effectivenessand quality of life associated with heavy menstrual bleedingamong women using the levonorgestrel-releasing intrauterinesystem. Int J Gynaecol Obstet 2011; 112: 171-8.
33. Heli&ouml;vaara-Peippo S, Hurskainen R, Teperi J et al. Quality oflife and costs of levonorgestrel-releasing intrauterine systemor hysterectomy in the treatment of menorrhagia: a 10-yearrandomized controlled trial. Am J Obstet Gynecol 2013; 209:535.e1-535.e14.
Volume 5, Issue 2, 2023
Page : 111-119
_Footer