TY - JOUR
T1 - Combined endometrial ablation and levonorgestrel intrauterine system use in women with dysmenorrhea and heavy menstrual bleeding
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.
N1 - Publisher Copyright:
© 2015 AAGL.
PY - 2015
Y1 - 2015
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.
KW - Dysmenorrhea
KW - Endometrial ablation (EA)
KW - Heavy menstrual bleeding (HMB)
KW - Levonorgestrel intrauterine system (LNG-IUS)
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U2 - 10.1016/j.jmig.2015.06.012
DO - 10.1016/j.jmig.2015.06.012
M3 - Article
C2 - 26122898
AN - SCOPUS:84952874280
SN - 1553-4650
VL - 22
SP - 1203
EP - 1207
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 7
ER -