Abstract | OBJECTIVE: DESIGN: Prospective observational case series (Canadian Task Force Classification II-3). SETTING: University affiliated teaching hospital. PATIENTS: INTERVENTIONS: From January 2002 through January 2007, 10 women were identified from the senior author's clinical practice (G.A.V.). After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, the LNG-IUS was placed to treat their AUB. MEASUREMENTS AND MAIN RESULTS: The median and range of age, parity, and body mass index were 45 years (34-49), 1 (0-4), and 38 kg/m(2) (26-52), respectively. All women were receiving warfarin therapy (4-12.5 mg/d) for previous venous thromboembolism. Some patients had additional comorbid conditions and were at high risk for traditional medical or surgical therapies. After placement of the LNG-IUS, all women reported menstrual reduction at 3 and 6 months. By 12 months, 1 woman with large fibroids expelled the LNG-IUS and was treated with transfemoral uterine artery embolization. Two women had amenorrhea, and 7 had hypomenorrhea. At 2 to 5 years, 1 woman expelled the LNG-IUS and hysterectomy indicated extensive adenomyosis in a 195-g uterus, and 1 woman had hysteroscopic endometrial ablation, 4 were menopausal, 2 had amenorrhea, and 1 had hypomenorrhea. In the 5 women with uterine fibroids measuring 4.2 to 147 cm(3), the fibroids were reduced in volume by approximately 75% in 2, were no longer detectable in 1, were subsequently shown to be adenomyoma in 1, and required uterine artery embolization in 1. CONCLUSION: In properly assessed and selected obese, premenopausal women with AUB receiving warfarin therapy and at high risk for traditional therapies, the LNG-IUS was an effective treatment in 70% of patients.
|
Authors | George A Vilos, Valentin Tureanu, Meivys Garcia, Basim Abu-Rafea |
Journal | Journal of minimally invasive gynecology
(J Minim Invasive Gynecol)
2009 Jul-Aug
Vol. 16
Issue 4
Pg. 480-4
ISSN: 1553-4650 [Print] United States |
PMID | 19573825
(Publication Type: Journal Article)
|
Chemical References |
- Anticoagulants
- Contraceptives, Oral, Synthetic
- Warfarin
- Levonorgestrel
|
Topics |
- Adult
- Anticoagulants
(therapeutic use)
- Contraceptives, Oral, Synthetic
(therapeutic use)
- Female
- Humans
- Intrauterine Devices, Medicated
- Levonorgestrel
(therapeutic use)
- Metrorrhagia
(complications, drug therapy)
- Middle Aged
- Obesity
(complications)
- Prospective Studies
- Thrombosis
(complications, prevention & control)
- Warfarin
(therapeutic use)
|