Resources and procedures in the treatment of heavy menstrual bleeding with the levonorgestrel-releasing intrauterine system (LNG-IUS) or hysterectomy in Brazil.

Abstract

BACKGROUND:

Heavy menstrual bleeding (HMB) is the most common complaint of women seeking gynecological care. Treatments included surgical or medical options including hysterectomy and the levonorgestrel-releasing intrauterine system (LNG-IUS) due to the profound suppression of endometrial growth that intrauterine LNG exerts which results in amenorrhea or in a reduction of blood loss.

OBJECTIVE:

The study was conducted to evaluate the resources and procedures involved in inserting an LNG-IUS compared to performing hysterectomy in women with HMB in a public sector hospital in Brazil.

STUDY DESIGN:

Two cohorts of women were studied: women who accepted an LNG-IUS (n=124) and matched women who underwent hysterectomy on the same day (n=122). We evaluate the number of procedures carried out in each group of women, including those performed before the decision was made to insert an LNG-IUS or to perform hysterectomy, the insertion of the device itself and the surgical procedure, in addition to the procedures and complications registered up to 1 year after LNG-IUS insertion or hysterectomy.

RESULTS:

Age and the duration of HMB were significantly lower in the LNG-IUS acceptors than women at the hysterectomy group. The numbers of gynecological consultations and Pap smears were similar in both groups; however, women in the hysterectomy group also underwent laboratory tests, ultrasonography, chest X-ray and electrocardiogram. In the hysterectomy group, the main complications were hemorrhage (six), bladder/bowel perforation (four), complications with anesthesia (one), ureteral reimplantation required (one) and abdominal pain (two). At 1 year, HMB was controlled in 83.1% of women in the LNG-IUS group, and 106 women continued with the device.

CONCLUSIONS:

Both treatments were effective in HMB control. Fewer resources and complications were observed in LNG-IUS acceptors when compared to hysterectomy. The LNG-IUS represents a good strategy for reducing the number of hysterectomies and the resources required for women with HMB.

• Authors: M Valeria Bahamondes, Yuri de Lima, Vanessa Teich, Luis Bahamondes, Ilza Monteiro
• Journal: Contraception (Contraception) Vol. 86 Issue 3 Pg. 244-50 (Sep 2012) ISSN: 1879-0518 [Electronic] United States
• PMID: 22459236 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Contraceptive Agents, Female
• Levonorgestrel

Topics

• Adult
• Brazil
• Cohort Studies
• Contraceptive Agents, Female (economics, therapeutic use)
• Female
• Health Resources (statistics & numerical data)
• Humans
• Hysterectomy (economics, statistics & numerical data)
• Intrauterine Device Expulsion
• Intrauterine Devices, Medicated
• Levonorgestrel (economics, therapeutic use)
• Menorrhagia (therapy)
• Middle Aged
• Postoperative Complications (epidemiology)