A PROSPECTIVE COMPARATIVE STUDY EVALUATING THE DIFFERENCE IN EFFICACY OF LNG-IUS IN TREATMENT OF AUB-L AND AUB-A

Dr. Afrah Basheer. Sr. Registrar, Apollo AdluxHospital, Angamaly, Kerala, India

OBJECTIVES
•TocomparetheefficacyofLNG-IUSinthetreatmentofabnormaluterinebleedingduetoleiomyomaandadenomyosis.
•TofindoutwhetherthereisareductioninuterineleiomyomasizeorintheuterinevolumeincaseofadenomyosiswithuseofLNG-IUS.

DESIGN
Population
Group 1 (n1=21): AUB-L
Group 2 (n2=21): AUB-A
Group allocation based on USG Findings
Intervention
•LNG-IUS
Outcome measure
•Primary outcome: Efficacy of LNG-IUS in treating AUB-L and AUB-A
•Secondary outcome
•ΔL (change in Leiomyoma size)
•ΔU (change in uterine volume for adenomyosis)
Objective
•Efficacy: LNG-IUS effectiveness in reducing AUB symptoms in both AUB L and AUB A
•Morphological impact
•For AUB-L : ΔL (reduction in Leiomyoma size)
•For AUB-A: ΔU (reduction in uterine volume for adenomyosis )

METHOD
Participants
•Total Sample Size:42 patients
oGroup A (n = 21):AUB due to Fibroids (Leiomyoma)
oGroup B (n = 21):AUB due to Adenomyosis
•Classification Method:Based on USG findings
Intervention
•Treatment Administered:LNG-IUS (Levonorgestrel Intrauterine System)
•Follow-Up Period:6 monthspost-insertion
•Assessment:Treatment response monitored during follow-up
Sample Size Calculation
Statistical Tool:G*Power (version 3.1.5)
Parameters Used:
oSignificance level (α):5%
oPower (1–β):80%
Minimum Total Sample Required:42
oGroup 1 (AUB-L):21

Fibroid Group (n=21)

Adenomyosis Group (n=21)
Past Medical History
76.2% had PMH (DM, HTN, thyroid); 23.8% none
66.7% had PMH; 33.3% none
Menstrual Cycle Regularity
85.7% regular, 14.3% irregular
81% regular, 19% irregular
Past Surgical History
57.1% had surgeries, 42.9% none
57.1% had surgeries, 42.9% none
HMB Duration
52.4% (6d), 19% (4d), 14.3% (3d), 9.5% (2d), 4.8% (8d)
38.1% (4d), 28.6% (6d), 19% (8d), 9.5% (5d), 4.8% (12d)
Conservative Medical Management
61.9% had, 38.1% none
81% had, 19% none
Change in HMB after LNG-IUS
90.5% ↓, 4.8% ↑, 4.8% no change
61.9% ↓, 9.5% ↑, 28.6% no change
Passage of Clots (Pre vs Post)
20 before; 4 after (↓ 80%) (p<0.001)
20 before; 6 after (↓ 70%) (p<0.001)
Dysmenorrhea (Pre vs Post)
10 before; 6 after (↓ 40%)
20 before; 12 after (↓ 40%) (p=0.008)
Change in Fibroid/Uterine Size
9.5% ↓; 61.9% no change
9.5% ↓, 38.1% same, 52.4% ↑
LNG-IUS Continuation/Expulsion
85.7% continued; 14.3% expelled
81% continued; 19% expelled
Statistical Significance (USG)
Fibroid size (p<0.001), volume, expulsion (p=0.001)
Expulsion only (p=0.002)
CONCLUSION
•Levonorgestrel-releasing intrauterine system, provides an incredible nonsurgical alternative in treatment of menorrhagia which is reversible and spares fertility.
•The safety of the device is high with no adverse effects on ovarian function except for increased risk of ovarian cysts.
REFERENCE
1.ThiyagarajanDK, BasitH, JeanmonodR. Physiology, Menstrual Cycle. [Updated 2022 Oct 24]. In: Stat Pearls .
2.Song SY, Lee SY, Kim HY, Park DB, Kim DE, Lee KH, Lee S, Yang JB, YooHJ.Long-term efficacy and feasibility of levonorgestrel-releasing intrauterine device use in patients with adenomyosis. Medicine (Baltimore). 2020 May 29;99(22):e20421. doi:10.1097/MD.0000000000020421. PMID: 32481439.
ACKNOWLEDGEMENT
•I thank Dr. K.K. Wariyar, Dr. Sreelatha Warrier, Dr. NejumunneesaM.K, and other consultants of Lakshmi Hospital, Kochi, for their support and permission to conduct this study.