Author: Leng Jinhua (Peking Union Medical College Hospital)
The levonorgestrel intrauterine contraceptive system is an intrauterine device.
In addition to being a highly effective contraceptive method, its role in the treatment of endometriosis (endometriosis) and adenomyosis is also worthy of recognition.
1. How does it work?
IUD can slowly release progesterone, mainly in the endometrium local role, so that the endometrium atrophy, can significantly reduce menstrual flow, relieve dysmenorrhea, in some endopathy and adenomyosis patients, has achieved good efficacy.
Because the drug effect makes the intimal membrane metamorphosis and atrophy, even if the intima is reversed to the pelvic cavity, it is not easy to form a new ectopic lesion, which plays a role in preventing endomegaly to a certain extent.
By inhibiting the synthesis of prostaglandins, dysmenorrhea is relieved.
Image source: Stand Cool Helo
2. Therapeutic advantages
Relieves pain and does not produce menopausal symptoms.
Multiple studies have shown that IUDs are effective in improving endopathy-related pain. Compared with drugs such as gonadotropin-releasing hormone agonists (GnRH-a), hypoestrogenemia does not cause hypoestrogenemia and does not produce menopausal symptoms.
Contraception also treats endopathy:
Since IUD can relieve pain, reduce menstrual flow, and prevent postoperative recurrence of endopathy while contraception, the mainland "Expert Consensus on the Clinical Application of Contraceptive Methods for Women" recommends the levonorgestrel intrauterine birth control system as the preferred long-acting contraceptive method for patients with endopathy.
3. Treatment of disadvantages
As one of the progestogen-only drugs, IUDs also have adverse effects of irregular vaginal bleeding in the early stages of the upper ring, most notably in the first 3 to 6 months of treatment, and can be gradually relieved over time.
4. Who is eligible?
IUDS are suitable for patients with endometriosis or adenomyosis who have no recent fertility requirements.
It can not only improve clinical symptoms such as menorrhagia, dysmenorrhea, chronic pelvic pain, and dyspareunia, but also prevent and control the progression of deep infiltrative endopathy and adenomyosis, and also play a preventive role in postoperative disease recurrence.
5. How to place?
Direct placement: Can be placed directly during menstruation avoiding heavy menstruation.
Combination drug placement: patients with severe pain with a uterine volume >8 weeks' gestation and a uterine cavity depth greater than 10 cm, with an VAS score (pain score, see figure below) of more than 7 points, and patients with anemia due to large menstrual flow, can be treated with drugs such as oral contraceptives, progesterone, and gonadotropin-releasing hormone agonists.
Intraoperative placement: If intraoperative findings with deep infiltrative endometriosis are found, doctors may place them intraoperatively.
6. The top ten groups of people need to be banned
People who are allergic to levonorgestrel;
Patients with abnormal liver function or a recent history of liver disease or jaundice;
Patients with breast cancer, genital tract malignancies, or other progestogen-dependent tumors;
Malignant lesions of the uterus or cervix;
Cervicitis, vaginitis and other lower genital tract infections;
Pelvic inflammatory disease or recurrent pelvic inflammatory disease;
postpartum endometritis, or patients who have had an infectious miscarriage within 3 months;
Abnormal development of the uterus and cervix;
People with unexplained abnormal uterine bleeding;
Known or suspected pregnancy.
7. Two types of people need to be used with caution
congenital heart disease, or valvular heart disease at risk of infective endocarditis;
Depressed patients.
8. Precautions after putting the ring
After the release of the ring, attention should be paid to the shedding of the ring, bleeding, and follow-up to evaluate whether there is a case of lower movement of the ring.
Initial follow-up 1 month after placement, and then every 3 to 6 months is generally recommended. Doctors adjust the frequency of visits based on the patient's condition.
Co-author: Dr. Li Xiaoyan, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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