THE CLINICAL EFFICACY OF SEQUENTIAL USE OF GONADOTROPIN-RELEASING HORMONE ANALOG - LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM IN MEDICALLY ILL WOMEN WITH SYMPTOMATIC AND RELATIVELY LARGE ADENOMYOSIS

Fadia J Alizzi
In: Asian Journal of Pharmaceutical and Clinical Research · 2018 · vol. 11(9) , pp. 144 · doi:10.22159/ajpcr.2018.v11i9.26847 · W2890028490
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Sequential treatment with GnRH agonist followed by a levonorgestrel-releasing intrauterine system effectively reduced menstrual blood loss, pelvic pain, and uterine volume in women with symptomatic adenomyosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This prospective cohort study evaluated sequential therapy with a gonadotropin-releasing hormone (GnRH) analog followed by insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) in 32 medically ill women aged 40 years and older with symptomatic, relatively large adenomyosis (uterine volume ≥150 cm³). Over 1 year of follow-up, menstrual blood loss volume and dysmenorrhea improved significantly, with most of the change occurring within the first 6 months, and uterine volume was significantly reduced. The study also reported an LNG-IUS expulsion rate of 15.6%. The paper does not explicitly state a comparator arm, which limits interpretation of effectiveness relative to other management strategies, and this study design affects the strength of causal conclusions. This paper is centrally about endometriosis? No: it is centrally about adenomyosis — specifically sequential GnRH analog followed by LNG-IUS for symptomatic large adenomyosis in medically ill women.

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Abstract

Objectives: To evaluate the clinical outcome of sequential therapy of gonadotropin-releasing hormone (GnRH) analog, followed by the levonorgestrel-releasing intrauterine system in medically ill women with relatively large and symptomatic adenomyosis.Methods: A prospective cohorts study conducted in the Obstetrics and Gynaecology Department, Al-Yarmouk teaching hospital in Baghdad/Iraq from June 2016 to January 2018. 32 women, 40 years and above who complete their family and had significant medical disease along with symptomatic and relatively large adenomyosis (≥150 cm3) were included in the study. The primary outcome measure was to evaluate the clinical outcome of this sequential therapy in the form of improving menstrual blood loss and pelvic pain and the secondary outcome was decreasing uterine volume.Results: There were significant improvements in both menstrual blood loss volume and dysmenorrhea at the end of the 1st year with p˂0.001, mainly in the first 6 months. There were also significant reductions in the uterine volume (197.2±30.7–91.5±6.0 mm3). The expulsion rate was 15.6%.Conclusion: Sequential treatment protocol of GnRH agonist - LNG-IUS in symptomatic and relatively large adenomyosis (˃150 cm3) is effective in relieving symptoms and decreasing uterine volume with less possible expulsion rate, making the protocol good substitutions to surgery, especially in medically ill women were surgery carry more risk.

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adenomyosisdysmenorrhea

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