The Treatment Effect Of LNG-IUS Combined With COC On Main Symptoms And Irregular Vaginal Bleeding In Patients With Adenomyosis

Objective:To explore the prevention and treatment effect of combined oral contraceptives on irregular vaginal bleeding in patients with adenomyosis using levonorgestrel intrauterine system(trade name:Mirena),and the impact on the symptoms of adenomyosis and the life quality of patients.To compare the difference of efficacy between Yasmin and Yasyue.Methods:Patients with adenomyosis who were treated in the outpatient treatment room of the Obstetrics and Gynecology Department of our hospital from August 2017 to August 2019 were selected according to the inclusion criteria and the elimination criteria.We used the randomized digital table method to divide the patients into four groups:group A(the control group,using LNG-IUS only),group B(LNG-IUS and hemostatic),group C(LNG-IUS and Yasmin),group D(LNG-IUS and Yasyue).We chose Baogong Zhixue particles as the hemostatic,with the same dosage for the patients in group B.The oral drugs of the experimental group and the control group were taken on the first day of the insertion of LNG-IUS,and the duration was 3 months.We took the method of online follow-up(internet and phone)and offline follow-up(outpatient)for all patients before LNG-IUS inserting and 3 months after inserting to collect the clinical message below:falling off or moving down of IUD,general information questionnaire,irregular vaginal bleeding,visual analogue scale(VAS),pictorial blood loss assessment chart(PBAC)and endometriosis health profile-5(EHP-5).Result:1.Falling off and moving down of IUD:A total of 480 patients were included in this study.15 patients lost follow-up,28 patients’ LNG-IUD fell off,and 62 patients’LNG-IUD moved down.A total of 105 cases above were excluded from this study,and 375 cases completed all follow-up.2.General information questionnaire:The age,dysmenorrhea and the history of pregnancy and delivery of all 375 patients were collected.Statistical analysis showed that there was no statistically significant of the difference between the four groups(p>0.05).3.The symptoms of adenomyosis:1)Dysmenorrhea:After 3 months of inserting the LNG-IUS,the VAS score of each group was significantly lower than that before inserting,and the difference was statistically significant(p<0.05).When comparing the VAS score between four groups,the difference had no statistically significant of both 3 months after inserting and before the inserting(p>0.05).2)Menstrual blood volume:After 3 months of inserting the LNG-IUS,the PBAC score of each group was significantly lower than that before inserting,and the difference had statistically significant(p<0.05).The PBAC score difference between four groups had no statistically significant before inserting the LNG-IUS.3 months after inserting,the PBAC scores of both group C and D were lower than those of group A and B,and group B was lower than that of group A,whose differences had statistically significant(p<0.05).The score of group C was slightly lower than that of group D,but the difference had no statistically significant(p>0.05).4.Irregular vaginal bleeding:3 months after inserting,the incidence of irregular bleeding in both group C and D were lower than those in group A and B,and group B was lower than group A,whose differences had statistically significant(p<0.05).The difference between group C and D in the incidence of irregular bleeding had no statistically significant(p>0.05).5.Living quality:After 3 months of inserting the LNG-IUS,the EHP-5 score of each group was significantly lower than that before inserting,and the difference had statistically significant(p<0.05).The EHP-5 score difference between four groups had no statistically significant before inserting the LNG-IUS(p>0.05).3 months after inserting,the EHP-5 score decreased from A to D,and the differences had statistically significant(p<0.05)Conclusions:COC can reduced the incidence of irregular vaginal bleeding caused by LNG-IUS,and reduce the menstrual blood volume,but it did not enhance the treatment effect of dysmenorrhea in patients with adenomyosis.COC combined with LNG-IUS could improve the life quality of patients with adenomyosis,and Yasyue was better than Yasmin.Baogong Zhixue particles could also play a role in reducing irregular vaginal bleeding and improving the life quality of patients with adenomyosis,but its effect was not as good as COC.