Combined endometrial ablation and levonorgestrel intrauterine system use in women with dysmenorrhea and heavy menstrual bleeding: Novel approach for challenging cases

Efstathios P. Papadakis, Sherif A. El-Nashar, Shannon K Laughlin-Tommaso, Sherif A M Shazly, Matthew R. Hopkins, Daniel M. Breitkopf, Abimbola O. Famuyide

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Study Objective: To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years. Design: Cohort study (Canadian Task Force II-2). Setting: An academic institution in the upper Midwest. Patients: All women with HMB and dysmenorrhea who underwent EA with combined placement of LNG-IUS (EA/LNG-IUS cohort, 23 women) after 2005 and an historic reference group from women who had EA alone (EA cohort, 65 women) from 1998 through the end of 2005. Intervention: Radiofrequency EA, thermal balloon ablation, and LNG-IUS. Measurements and Main Results: The primary outcome was treatment failure defined as persistent pain, bleeding, and hysterectomy after EA at 4 years. The combined treatment failure outcome was documented in 2 patients (8.7%) in the EA/LNG-IUS group and 19 patients (29.2%) in the EA group with an unadjusted OR of .23 (95% CI, .05-1.08). After adjusting for known risk factors of failure, the adjusted OR was .19 (95% CI, .26-.88). None of the women who underwent EA/LNG-IUS had hysterectomy for treatment failure compared with 16 (24%) in the EA group (p = .009); postablation pelvic pain was documented in 1 woman (4.3%) in the EA/LNG-IUS group compared with 8 women (12.3%) in the EA group (p = .24). One woman in the EA/LNG-IUS group (4.3%) presented with persistent bleeding compared with 15 (23.1%) in the EA group (p = .059). Office removal of the intrauterine device was performed in 4 women with no complications. Conclusion: LNG-IUS insertion at the time of EA is feasible and can provide added benefit after EA in women with dysmenorrhea and HMB.

Original languageEnglish (US)
Pages (from-to)1203-1207
Number of pages5
JournalJournal of Minimally Invasive Gynecology
Volume22
Issue number7
DOIs
StatePublished - 2015

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Endometrial Ablation Techniques
Levonorgestrel
Dysmenorrhea
Hemorrhage
Treatment Failure
Hysterectomy

Keywords

  • Dysmenorrhea
  • Endometrial ablation (EA)
  • Heavy menstrual bleeding (HMB)
  • Levonorgestrel intrauterine system (LNG-IUS)

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Combined endometrial ablation and levonorgestrel intrauterine system use in women with dysmenorrhea and heavy menstrual bleeding : Novel approach for challenging cases. / Papadakis, Efstathios P.; El-Nashar, Sherif A.; Laughlin-Tommaso, Shannon K; Shazly, Sherif A M; Hopkins, Matthew R.; Breitkopf, Daniel M.; Famuyide, Abimbola O.

In: Journal of Minimally Invasive Gynecology, Vol. 22, No. 7, 2015, p. 1203-1207.

Research output: Contribution to journalArticle

Papadakis, Efstathios P. ; El-Nashar, Sherif A. ; Laughlin-Tommaso, Shannon K ; Shazly, Sherif A M ; Hopkins, Matthew R. ; Breitkopf, Daniel M. ; Famuyide, Abimbola O. / Combined endometrial ablation and levonorgestrel intrauterine system use in women with dysmenorrhea and heavy menstrual bleeding : Novel approach for challenging cases. In: Journal of Minimally Invasive Gynecology. 2015 ; Vol. 22, No. 7. pp. 1203-1207.
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abstract = "Study Objective: To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years. Design: Cohort study (Canadian Task Force II-2). Setting: An academic institution in the upper Midwest. Patients: All women with HMB and dysmenorrhea who underwent EA with combined placement of LNG-IUS (EA/LNG-IUS cohort, 23 women) after 2005 and an historic reference group from women who had EA alone (EA cohort, 65 women) from 1998 through the end of 2005. Intervention: Radiofrequency EA, thermal balloon ablation, and LNG-IUS. Measurements and Main Results: The primary outcome was treatment failure defined as persistent pain, bleeding, and hysterectomy after EA at 4 years. The combined treatment failure outcome was documented in 2 patients (8.7{\%}) in the EA/LNG-IUS group and 19 patients (29.2{\%}) in the EA group with an unadjusted OR of .23 (95{\%} CI, .05-1.08). After adjusting for known risk factors of failure, the adjusted OR was .19 (95{\%} CI, .26-.88). None of the women who underwent EA/LNG-IUS had hysterectomy for treatment failure compared with 16 (24{\%}) in the EA group (p = .009); postablation pelvic pain was documented in 1 woman (4.3{\%}) in the EA/LNG-IUS group compared with 8 women (12.3{\%}) in the EA group (p = .24). One woman in the EA/LNG-IUS group (4.3{\%}) presented with persistent bleeding compared with 15 (23.1{\%}) in the EA group (p = .059). Office removal of the intrauterine device was performed in 4 women with no complications. Conclusion: LNG-IUS insertion at the time of EA is feasible and can provide added benefit after EA in women with dysmenorrhea and HMB.",
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T2 - Novel approach for challenging cases

AU - Papadakis, Efstathios P.

AU - El-Nashar, Sherif A.

AU - Laughlin-Tommaso, Shannon K

AU - Shazly, Sherif A M

AU - Hopkins, Matthew R.

AU - Breitkopf, Daniel M.

AU - Famuyide, Abimbola O.

PY - 2015

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N2 - Study Objective: To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years. Design: Cohort study (Canadian Task Force II-2). Setting: An academic institution in the upper Midwest. Patients: All women with HMB and dysmenorrhea who underwent EA with combined placement of LNG-IUS (EA/LNG-IUS cohort, 23 women) after 2005 and an historic reference group from women who had EA alone (EA cohort, 65 women) from 1998 through the end of 2005. Intervention: Radiofrequency EA, thermal balloon ablation, and LNG-IUS. Measurements and Main Results: The primary outcome was treatment failure defined as persistent pain, bleeding, and hysterectomy after EA at 4 years. The combined treatment failure outcome was documented in 2 patients (8.7%) in the EA/LNG-IUS group and 19 patients (29.2%) in the EA group with an unadjusted OR of .23 (95% CI, .05-1.08). After adjusting for known risk factors of failure, the adjusted OR was .19 (95% CI, .26-.88). None of the women who underwent EA/LNG-IUS had hysterectomy for treatment failure compared with 16 (24%) in the EA group (p = .009); postablation pelvic pain was documented in 1 woman (4.3%) in the EA/LNG-IUS group compared with 8 women (12.3%) in the EA group (p = .24). One woman in the EA/LNG-IUS group (4.3%) presented with persistent bleeding compared with 15 (23.1%) in the EA group (p = .059). Office removal of the intrauterine device was performed in 4 women with no complications. Conclusion: LNG-IUS insertion at the time of EA is feasible and can provide added benefit after EA in women with dysmenorrhea and HMB.

AB - Study Objective: To evaluate the feasibility and impact of levonorgestrel intrauterine system (LNG-IUS) on treatment failure after endometrial ablation (EA) in women with heavy menstrual bleeding (HMB) and dysmenorrhea at 4 years. Design: Cohort study (Canadian Task Force II-2). Setting: An academic institution in the upper Midwest. Patients: All women with HMB and dysmenorrhea who underwent EA with combined placement of LNG-IUS (EA/LNG-IUS cohort, 23 women) after 2005 and an historic reference group from women who had EA alone (EA cohort, 65 women) from 1998 through the end of 2005. Intervention: Radiofrequency EA, thermal balloon ablation, and LNG-IUS. Measurements and Main Results: The primary outcome was treatment failure defined as persistent pain, bleeding, and hysterectomy after EA at 4 years. The combined treatment failure outcome was documented in 2 patients (8.7%) in the EA/LNG-IUS group and 19 patients (29.2%) in the EA group with an unadjusted OR of .23 (95% CI, .05-1.08). After adjusting for known risk factors of failure, the adjusted OR was .19 (95% CI, .26-.88). None of the women who underwent EA/LNG-IUS had hysterectomy for treatment failure compared with 16 (24%) in the EA group (p = .009); postablation pelvic pain was documented in 1 woman (4.3%) in the EA/LNG-IUS group compared with 8 women (12.3%) in the EA group (p = .24). One woman in the EA/LNG-IUS group (4.3%) presented with persistent bleeding compared with 15 (23.1%) in the EA group (p = .059). Office removal of the intrauterine device was performed in 4 women with no complications. Conclusion: LNG-IUS insertion at the time of EA is feasible and can provide added benefit after EA in women with dysmenorrhea and HMB.

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KW - Endometrial ablation (EA)

KW - Heavy menstrual bleeding (HMB)

KW - Levonorgestrel intrauterine system (LNG-IUS)

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