Hysteroscopic Endomyometrium Resection combined with concomitant Insertion of LNG-IUS for Treatment of Symptomatic Adenomyosis; A 5-year follow up result.

Main Article Content

Yi Liang Lee, MD Yin-Shium Bai, MPhil. PhD candidate Chang Sheng Yin, MD

Abstract

Background: Treatment for patients with symptomatic adenomyosis has been mainly by hysterectomy. The aim of this 5-year observational study was to assess the feasibility of Hysteroscopic Endomyometrium Resection with concomitant Insertion of LNG-IUD for symptomatic adenomyosis.


Methods: From May 2015 and December 2022, a group of 36 women with symptomatic adenomyosis underwent this combined modality treatment at a community hospital. The core outcomes of the study were effective rate of dysmenorrhea, menorrhagia, secondary outcomes as hysterectomy, IUD expulsion, or premature removal, repeated the procedures.


Results: The study followed the progress of 36 women, aged 42.9±4, over a period of five years. The procedures were performed safely, and no complications were observed. The total successful rate of amenorrhea was 27 of 36 (75%). For the Pain Control, the intervention led to a significant reduction in pain scores, with the mean pain score decreasing by approximately 63.4% (95% CI: -64.3% to -62.5%). For the Blood Loss, with the mean blood loss decreasing by approximately 75.77% (95% CI: 32.93% to 118.61%). The study also showed reduced CA-125 level, reduction in uterine length and volume, about 70% of patients reported being very satisfied and satisfied of this combined treatment.


Conclusion: We demonstrated this combined modality is feasible and safe for treatment of symptomatic adenomyosis.

Keywords: Symptomatic Adenomyosis, Transcervical endomyometrium resection (TCREM), LNG-IUD

Article Details

How to Cite
LEE, Yi Liang; BAI, Yin-Shium; YIN, Chang Sheng. Hysteroscopic Endomyometrium Resection combined with concomitant Insertion of LNG-IUS for Treatment of Symptomatic Adenomyosis; A 5-year follow up result.. Medical Research Archives, [S.l.], v. 11, n. 12, jan. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4566>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v11i12.4566.
Section
Case Reports

References

1. Upson K, Missmer SA. Epidemiology of Adenomyosis. Semin Reprod Med 2020; 38:89.

2. Levgur M, Abadi M. A., Tucker A. Adenomyosis: symptoms, histology, and pregnancy terminations. Obstetrics & Gynecology. 2000;95(5):688–691. doi:

3. F-S Peng, M-Y Wu, J-H Yan, S-U Chen, H-N Ho, Y-S Yang. Insertion of the Mirena Intrauterine System for Treatment of Adenomyosis-Associated Menorrhagia: A Novel Method. Taiwanese Journal of Obstetrics and Gynecology, Volume 49, Issue 2, June 2010, Pages 160-164, https://doi.org/10.1016/S1028-4559(10)60034-4.

4. Wortman M, Daggett A. Hysteroscopic endomyometrial resection. JSLS. 2000 Jul-Sep;4(3):197-207. PMID: 10987395; PMCID: PMC3113171.

5. W Xia, D Zhang, Q Zhu, H Zhang, S Yang, J Ma, H Pan, T Tong, J Sun, J Zhang, Hysteroscopic excision of symptomatic myometrial adenomyosis: feasibility and effectiveness. BJOG. 2017 Sep https://doi.org/10.1111/1471-0528.14673

6. Maia H Jr, Maltez A, Coelho G, et al. Insertion of Mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 2003; 10:512-6.

7. Akmal Zulayla Mohd Zahid, Noorneza Abdul Rahman, Zatul Akmar Ahmad, Combination of hysteroscopic resection of endomyometrium with insertion of Mirena: An alternative treatment for adenomyosis, CASE REPORT, Med J Malaysia, Vol 76 No 4 July 2021.

8. Magnay JL, Nevatte TM, O'Brien S, Gerlinger C, Seitz C. Validation of a new menstrual pictogram (superabsorbent polymer-c version) for use with ultraslim towels that contain superabsorbent polymers. Fertil Steril. 2014 Feb;101(2):515-22. doi: 10.1016/j.fertnstert.2013.10.051. Epub 2013 Dec 12. PMID: 24331833.

9. Sun YL, Wang CB, Lee CY, Wun TH, Lin P, Lin YH, Tseng CC, Chen CH, Tseng CJ. Transvaginal sonographic criteria for the diagnosis of adenomyosis based on histopathologic correlation. Taiwan J Obstet Gynecol. 2010 Mar;49(1):40-4. doi: 10.1016/S1028-4559(10)60007-1. PMID: 20466291.

10. Nidhi, Kumari A, Tirkey S, Prakash J. Effectiveness of Levonorgestrel Releasing Intrauterine System in Perimenopausal Women with Heavy Menstrual Bleeding: A Prospective Study at a Teaching Hospital in India. J Menopausal Med. 2022 Dec;28(3):128-135. doi: 10.6118/jmm.22025. PMID: 36647276; PMCID: PMC9843034.

11. Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. FertilSteril.2014,Feb;101(2):472-87. doi: 10.1016/j.fertnstert.2013.10.025. Epub 2013 Nov 26. PMID: 24289992.

12. Tellum T, Omtvedt M, Naftalin J, Hirsch M, Jurkovic D. A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis. Hum Reprod Open. 2021 Aug 7;2021(3):hoab030. doi: 10.1093/hropen/hoab030. PMID: 34466664; PMCID: PMC8398753.

13. Arakawa, I., Momoeda, M., Osuga, Y. et al. Cost-effectiveness of the recommended medical intervention for the treatment of dysmenorrhea and endometriosis in Japan. Cost Eff Resour Alloc 16, 12 (2018). https://doi.org/10.1186/s12962-018-0097-8