2022 Update on abnormal uterine bleeding
Insights into the COVID-19 vaccine’s effects on menstrual cycle irregularities; results of an RCT that examined the use of drospirenone 4 mg in a 24/4 regimen as an AUB treatment; a systematic review on placing a levonorgestrel-releasing intrauterine system after endometrial ablation; and a cost-effectiveness analysis of 2 treatments for HMB
Placing an LNG IUS after endometrial ablation for heavy menstrual bleeding reduced risk of hysterectomy
Oderkerk TJ, van de Kar MMA, van der Zanden CHM, et al. The combined use of endometrial ablation or resection and levonorgestrel-releasing intrauterine system in women with heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand. 2021;100:1779-1787.
Over the years, a smattering of articles have suggested that a reduction in uterine bleeding was associated with placement of an LNG IUS at the conclusion of endometrial ablation. We now have a systematic review of this surgical modification.
Oderkerk and colleagues sifted through 747 articles to find 7 publications that could provide meaningful data on the impact of combined use of endometrial ablation and LNG IUS insertion for women with heavy menstrual bleeding.5 These included 4 retrospective cohort studies with control groups, 2 retrospective studies without control groups, and 1 case series. The primary outcome was the hysterectomy rate after therapy.
Promising results for combined therapy
Although no statistically significant intergroup differences were seen in the combined treatment group versus the endometrial ablation alone group for the first 6 months of treatment, significant differences existed at the 12- and 24-month mark. Hysterectomy rates after combined treatment varied from 0% to 11% versus 9.4% to 24% after endometrial ablation alone. Complication rates for combined treatment did not appear higher than those for endometrial ablation alone.
The authors postulated that the failure of endometrial ablation is generally caused by either remaining or regenerating endometrial tissue and that the addition of an LNG IUS allows for suppression of endometrial tissue. Also encouraging was that, in general, the removal of the LNG IUS was relatively simple. A single difficult removal was described due to uterine synechiae, but hysteroscopic resection was not necessary. The authors acknowledged that the data from these 7 retrospective studies are limited and that high-quality research from prospective studies is needed.
Bottom line
The data available from this systematic review suggest that placement of an LNG IUS at the completion of an endometrial ablation may result in lower hysterectomy rates, without apparent risk, and without significantly difficult LNG IUS removal when needed.
The data provided by Oderkerk and colleagues’ systematic review are promising and, although not studied in the reviewed publications, the potential may exist to reduce the risk of endometrial hyperplasia and endometrial cancer by adding an LNG IUS.
Continue to: LNG IUS is less expensive, and less effective, than endometrial ablation for heavy menstrual bleeding, cost analysis shows...
