Relationship between uterine volume and discontinuation of treatment with levonorgestrel-releasing intrauterine devices in patients with adenomyosis

Ki Hwan Lee, Jang Kew Kim, Min A Lee, Young Bok Ko, Jung Bo Yang, Byung Hun Kang, Heon Jong Yoo
Archives of gynecology and obstetrics · 2016 · vol. 294(3) , pp. 561–566 · doi:10.1007/s00404-016-4105-y · PMID:27155971 · W2347171565
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

This study found that a uterine volume over 150 mL was significantly associated with levonorgestrel-releasing intrauterine device treatment failure in adenomyosis patients.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective study evaluated 171 women with adenomyosis treated with a levonorgestrel-releasing intrauterine device (LNG-IUD) between 2009 and 2011, comparing baseline and post-insertion measures of menorrhagia, dysmenorrhea, and uterine volume, and tracking premature discontinuation/treatment failure. About 22% (37/171) discontinued prematurely, with no differences in measured clinical characteristics between ongoing treatment and failure groups, but uterine volume differed significantly (178 ± 14 mL vs 141 ± 7 mL). Receiver operating characteristic analysis identified uterine volume >150 mL as significantly associated with LNG-IUD failure (AUC 0.763), and in univariate analysis uterine volume >150 mL was the only independent factor (OR 6.76). This paper is centrally about endometriosis and/or adenomyosis — it specifically examines adenomyosis patients and links higher uterine volume (>150 mL) to LNG-IUD discontinuation/failure.

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Abstract

Objective This study is to evaluate the relationship between the uterine volume and the failure of levonorgestrel-releasing intrauterine device (LNG-IUD) in patients with adenomyosis.

Methods

A total of 171 women with adenomysis were treated with LNG-IUD from November 2009 to December 2011. The amount of menorrhagia, degree of dysmenorrhea, and the uterine volume were compared before and after insertion of LNG-IUD, and the treatment failure of LNG-IUD was observed.

Results

The mean age of the participants was 42.5 years (range 29–53 years). The mean uterine volume was 158 mL (range 46–769 mL). Among the total participants, 37 (21.6 %) discontinued the treatment prematurely. There were no different characteristics between the ongoing treatment group and treatment failure group with LNG-IUD. However, there was significant difference of uterine volume between two groups (178 ± 14 and 141 ± 7 mL, P = 0.010). Based on the receiver operator characteristic analysis, the optimum cutoff value of uterine volume more than 150 mL was significantly associated with failure of LNG-IUD (area under curve: 0.763, 95 % CI 0.669–0.856). In univariate analysis, the uterine volume more than 150 mL was the only independent factor for the failure of LNG-IUD (odds ratio 6.76, 95 % CI 1.20–38.02, P = 0.030).

Conclusion

The rate of treatment failure after LNG-IUD insertion for the patients with adenomyosis was related to the uterine volume. Specifically, the treatment failure rate of large volume uterus (>150 mL) with LNG-IUD was significantly higher than that of small volume uterus. Similar content being viewed by others

References

Cho S, Nam A, Kim H, Chay D, Park K, Cho DJ et al (2008) Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. Am J Obstet Gynecol 198(373):e1–e7 Yoo HJ, Lee MA, Ko YB, Yang JB, Kang BH, Lee KH (2012) The efficacy of the levonorgestrel-releasing intrauterine system in perimenopausal women with menorrhagia or dysmenorrhea. Arch Gynecol Obstet 285:161–166 Socolov D, Blidaru I, Tamba B, Miron N, Boiculese L, Socolov R (2011) Levonorgestrel releasing-intrauterine system for the treatment of menorrhagia and/or frequent irregular uterine bleeding associated with uterine leiomyoma. Eur J Contracept Reprod Health Care 16:480–487 Abu Hashim H, Zayed A, Ghayaty E, El Rakhawy M (2013) LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women: a randomized controlled trial. J Gynecol Oncol 24:128–134 Kaunitz AM, Inki P (2012) The levonorgestrel-releasing intrauterine system in heavy menstrual bleeding: a benefit-risk review. Drugs 72:193–215 Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16:2427–2433 Fedele L, Bianchi S, Dorta M, Arcaini L, Zanotti F, Carinelli S (1992) Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. Fertil Steril 58:94–97 Higham JM, O’Brien PM, Shaw RW (1990) Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol 97:734–739 Dixon JS, Bird HA (1981) Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis 40:87–89 DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845 Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293 Bahamondes L, Diaz J, Marchi NM, Petta CA, Cristofoletti ML, Gomez G (1995) Performance of copper intrauterine devices when inserted after an expulsion. Hum Reprod 10:2917–2918 Merki-Feld GS, Schwarz D, Imthurn B, Keller PJ (2008) Partial and complete expulsion of the Multiload 375 IUD and the levonorgestrel-releasing IUD after correct insertion. Eur J Obstet Gynecol Reprod Biol 137:92–96 Sivin I, Stern J, Coutinho E, Mattos CE, el Mahgoub S, Diaz S et al (1991) Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS. Contraception 44:473–480 Reinhold C, Atri M, Mehio A, Zakarian R, Aldis AE, Bret PM (1995) Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology 197:609–614 Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors have no financial disclosures to declare and no conflicts of interest to report. Ethical approval While preparing this manuscript, we have strictly followed not only the instructions for authors as specified by Archives of Gynecology and obstetrics, but also the guidelines of the Ethic Committee of the Chungnam National University Hospital, Korea and the provisions of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the Chungnam National University Hospital, Korea (2013-08-038). Patient anonymity was completely preserved and the unique nature of identifying patients was not included in this manuscript. Informed consent This is retrospective study. Informed consent was not needed to obtain from all individual participants included in the study. Rights and permissions About this article Cite this article Lee, K.H., Kim, J.K., Lee, M.A. et al. Relationship between uterine volume and discontinuation of treatment with levonorgestrel-releasing intrauterine devices in patients with adenomyosis. Arch Gynecol Obstet 294, 561–566 (2016). https://doi.org/10.1007/s00404-016-4105-y Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-016-4105-y

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Intrauterine Devices, Medicated Levonorgestrel Uterus Adenomyosis Adenomyosis Adult Female Humans Intrauterine Devices, Medicated Levonorgestrel Middle Aged Retrospective Studies Treatment Failure Uterus

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