Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging

被引:140
作者
Bragheto, Aristides M.
Caserta, Nelson
Bahamondes, Luis
Petta, Carlos A. [1 ]
机构
[1] Dept Obstet & Gynecol, Human Reprod Unit, BR-13084971 Campinas, SP, Brazil
[2] Univ Estadual Campinas, Sch Med, Dept Radiol, BR-13084971 Campinas, Brazil
基金
巴西圣保罗研究基金会;
关键词
adenomyosis; levonorgestrel-releasing intrauterine system; magnetic resonance imaging; UTERINE JUNCTIONAL ZONE; HISTOPATHOLOGIC CORRELATION; ENDOVAGINAL US; UTERUS; ULTRASONOGRAPHY; MENORRHAGIA; DIFFUSE; WOMEN;
D O I
10.1016/j.contraception.2007.05.091
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Background: This study was conducted to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on adenomyotic lesions diagnosed and monitored by magnetic resonance imaging (MRI). Study Design: LNG-IUS was inserted during menstrual bleeding in 29 women, 24 to 46 years of age, with MRI-diagnosed adenomyosis associated with menorrhagia and dysmenorrhea. Clinical evaluations were carried out at baseline and at 3 and 6 months postinsertion. MRI was performed at baseline and at 6 months postinsertion and was used to calculate junctional zone thickness (in mm), to define the junctional zone borders, to identify the presence of high-signal foci on T-2-weighted images and to calculate uterine volume (in mL). Results: A significant reduction of 24.2% in junctional zone thickness was observed (p <.0001); however, no significant decrease in uterine volume was observed (142.6 mL vs. 136.4 mL; p=.2077) between baseline and the 6-month evaluation. A significant decrease in pain score was observed at 3 and 6 months after insertion (p <.0001); however, six women continued to report pain scores > 3 at 6 months of observation. At 3 months of use, the most common bleeding pattern was spotting, and at 6 months of observation, oligomenorrhea was the most common pattern observed, although spotting was present in one third of the women. Conclusions: The insertion of an LNG-TUS led to a reduction in pain and abnormal bleeding associated with adenomyosis. MRI was useful for monitoring response of adenomyotic lesions to the LNG-fUS. (c) 2007 Elsevier Inc. All rights reserved.
引用
收藏
页码:195 / 199
页数:5
相关论文
共 20 条
[1]  
ARNOLD LL, 1994, FERTIL STERIL, V61, P1165
[2]   Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology [J].
Bazot, M ;
Cortez, A ;
Darai, E ;
Rouger, J ;
Chopier, J ;
Antoine, JM ;
Uzan, S .
HUMAN REPRODUCTION, 2001, 16 (11) :2427-2433
[3]   Prevalence and risk factors of adenomyosis at hysterectomy [J].
Bergholt, T ;
Eriksen, L ;
Berendt, N ;
Jacobsen, M ;
Hertz, JB .
HUMAN REPRODUCTION, 2001, 16 (11) :2418-2421
[4]   UTERINE JUNCTIONAL ZONE - FUNCTION AND DISEASE [J].
BROSENS, JJ ;
DESOUZA, NM ;
BARKER, FG .
LANCET, 1995, 346 (8974) :558-560
[5]   Diffuse and focal adenomyosis: MR imaging findings [J].
Byun, JY ;
Kim, SE ;
Choi, BG ;
Ko, GY ;
Jung, SE ;
Choi, KH .
RADIOGRAPHICS, 1999, 19 :S161-S170
[6]   Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis [J].
Dueholm, M ;
Lundorf, E ;
Hansen, ES ;
Sorensen, JS ;
Ledertoug, S ;
Olesen, F .
FERTILITY AND STERILITY, 2001, 76 (03) :588-594
[7]   Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device [J].
Fedele, L ;
Bianchi, S ;
Raffaelli, R ;
Portuese, A ;
Dorta, M .
FERTILITY AND STERILITY, 1997, 68 (03) :426-429
[8]   Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system [J].
Fong, YF ;
Singh, K .
CONTRACEPTION, 1999, 60 (03) :173-175
[9]  
He Shu-ming, 2005, Zhonghua Fu Chan Ke Za Zhi, V40, P536
[10]  
HENDRICKSON MR, 1980, SURG PATHOLOGY UTERI, P452