The Clinical Efficacy Observation Of Mirena Combined GnRH-α, Oral Contraceptives For The Treatment Of Adenomyosis

BackgroundAdenomyosis (AM) refers to the endometrium to the muscular layer in whichbenign infiltration and diffuse growth, its characteristic is in myometrium ectopicendometrium and glands, accompanied by the surrounding muscle cell hypertrophyand hyperplasia. Adenomyosis is a kind of common disease for women, has a greatinfluence for health problems, over40multipara is a high incidence of the crowd.About70%of the patients had obvious clinical symptoms, its main performances aremenorrhagia, menstrual extension, and the progressive dysmenorrhea, infertility, etc.The current major modalities for the treatments of adenomyosis are surgery, oralhormone therapy, interventional therapy and levonorgestrel-releasing intrauterinesystem (Levonorgestrel Intrauterine System, LNG-IUS) intrauterine drugtreatment.Multiple clinical treatment to control symptoms, conventional treatmentoptions for surgical resection and hormone therapy, but each has flaws, compliance ofpatient is poor. Although hysterectomy is an effective cure, but suitable for olderpatients with no fertility requirements, and the uterus is a great significance organ, thesurgery itself, there are some risks, it do not apply for the young women with fertilityrequirements. Most of interventional treatment of uterine artery embolization law, but its efficacy varies greatly in different reports, therefore treatment has not beenuniversally carried out. Oral medication can temporarily relieve symptoms, but easyto relapse after treatment, and the impact on ovarian function, there is the risk ofcausing premature ovarian failure. In recent years, levonorgestrel releasingintrauterine system (Mirena) adenomyosis as a new treatment for attention.Mirena is a new intrauterine system containing levonorgestrel releasingintrauterine20μg to levonorgestrel daily, with high contraceptive reliability, has beenwidely used in clinical practice. The treatment of common gynecological diseases,especially menorrhagia, endometriosis, clinical observation, has conducted in-deepthresearch. Mirena can effectively improve the patient’s dysmenorrhea, reducemenstrual blood, shortened menstrual and improve symptoms of anemia. Mirenasustained high concentrations of progesterone acts on the uterine cavity, without livermetabolism, prolonged use of small impact on liver and kidney function, its mainmechanism of action is to sustain slow release of levonorgestrel in the uterine cavityto form a high levels of progesterone, it directly inhibits the growth of endometrialdecidualization, some patients have temporary amenorrhea. But Mirena placed twoproblems: irregular vaginal bleeding and decyclizing to influence satisfaction ofpatients.ObjectiveTo research levonorgestrel releasing intrauterine system (IUS) in the treatmentof adenomyosis, if Mirena combined GnRH-a, oral contraceptives can improve thesituation the irregular vaginal bleeding and shedding ring.Methods1MaterialsFrom May2012to May2013outpatients Mirena placed adenomyosis120patients clinical data,they have significant clinical symptoms and ultrasound showedvarying degrees of increased uterine lesions without obvious boundaries, strong coarse uneven internal echo, accompanied hypoechoic or anechoic sizes small darkareas, color Doppler flow imaging (CDFI) no blood visible around the lesionsurrounded by sparse interior visible star-like flow signals.On which agroup(Diphereline+Mirena group)40patients: ultrasound showed enlarged uterus(uterine>10cm), aged30to44years, mean37.5years, gravidity2to6times of themenstrual cycle24~45d, a history of menstrual flow more35cases (menstrual flow>80ml),28cases of dysmenorrhea, this group of patients given intramuscularDiphereline three months, review the ultrasound showed intrauterine <10cm, thenput the ring; ultrasound showed more than80cases of uterine <10cm, its groupb(Mirena+Yasmin group)40patients: Age31to45years, mean36.9years of age,gravidity2~6times of the menstrual cycle25~44d, a history of menstrual flowmore in37cases (menstrual flow>80ml),26cases of dysmenorrhea, used Yasminoral tablets three months after Mirena was placed;c group (Mirena group)40patients: Place only Mirena ring, aged31to46years, mean37.9years of age,gravidity2to6times of the menstrual cycle23~46d, there are more previousmenstrual flow in36patients (menstrual flow>80ml), dysmenorrhea27cases. Age,gravidity, number of days of menstruation, menstruation, caesarean section, birthnumber of cases there was no significant difference (P>0.05), comparable.2MethodsThe patients with adenomyosis, have fertility requirements or refusehysterectomy patients, upon examination no contraindications for using IUD,explaining the situation to the patient what may occur after placement, the patientasexual life for5days informed consent in menstrual, placed Mirena by aprofessional physician. A group of40patients: Mirena is placed after using3monthsDiphereline, injected once every four weeks(3.75mg), palced Mirena after threeinjections. B group of40patients: patients after Mirena is placed Yasmin oral tablets,each a day, once every21days, and stop the drug for7days and to continue treatmentwith the former, for taking three months. C group of40patients: place only Mirenaring.All patients need to review ultrasound to determine the position loop after thefirst menstruation. Telephoned after three and six months, to ask them the time of irregular bleeding, the ring off, relieve dysmenorrhea(pain score＜3), menstrualimprove(menstrual flow＜80ml) Everyone has a telephone follow-up.ResultsThe rates of decyclizing were: a group:0.0%, b group:17.5%, c group:20.0%.Agroup decyclizing lower than c group, the difference was statistically significant (P<0.05); b and c group decyclizing rate was no significant (P>0.05); a groupdecyclizing lower than b group, the difference was statistically significant (P <0.05).The rates of irregular vaginal bleeding were:5.0%, b group:27.5%, c group:75.0%.agroup the incidence of irregular bleeding and c statistically significant differencebetween the two groups (P <0.05); b group irregular vaginal bleeding was lower thanc group, the difference was statistically significant (P <0.05); a group the incidenceof irregular bleeding and b group difference was statistically significant (P <0.05).The degree of dysmenorrhea, menstrual improvement, three showed no significantdifference (P>0.05).ConclusionMirena placed separately and placed around the joint administration of treatmentcan reduce the incidence of pain and improvement of menstruation, can improve theclinical symptoms of adenomyosis. Combination therapy can prevent complicationsafter placed Mirena, and should be widely applied clinically.