Case Report with Review of Literature: Pregnancy After TCRM Plus Insertion of LNG IUS

Main Article Content

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

Abstract

Case: A 43-year-old woman (gravida 1, para 1) presented to our clinic requesting termination of a 6-week pregnancy. Her medical history was significant for menorrhagia, dysmenorrhea who was treated by transcervical resection of the endomyometrium (TCREM) followed by the immediate insertion of a levonorgestrel-releasing intrauterine device (LNG IUS) 7 years previously.


Introduction: Treating adenomyosis in women who wish to preserve their uterus remains a challenging task. TCREM followed by the immediate insertion of LNG IUS is rarely reported.


Objective: To provide an updated analysis of this combined treatment as an alternative treatment for adenomyosis.


Mechanism: High local levels of LNG from the LNG IUS downregulate estrogen receptors in the endomyometrium, leading to tissue atrophy and thereby preventing further estrogen stimulation.


Materials and Methods: A literature review was performed using PubMed, Google Scholar, and the Cochrane Library for studies addressing TCREM plus LNG-IUS for symptomatic adenomyosis published between January 2000 and December 2023.


Results: Three relevant papers were identified. One study reported a 12-month amenorrhea rate of 100% (p<0.001) post-intervention, with a 90% reduction in dysmenorrhea, while control groups had a 19% reintervention rate. The single-arm observational study with a 5-year follow-up found a 75% amenorrhea rate, reduced VAS score, blood loss, and uterine size (p<0.001, p<0.001, p=0.005, respectively), a hysterectomy reintervention rate of 6%, IUD expulsion in 8%, premature removal in 11%, and a 70% patient satisfaction rate. The case series report included 2 women with six months of follow-up; both reported light bleeding and no dysmenorrhea.


Conclusion: The combination therapy appears promising for treating symptomatic adenomyosis with high rates of amenorrhea and patient satisfaction. However, additional high-quality research is necessary due to the small sample size and methodological limitations in the current studies.

Keywords: pregnancy, adenomyosis, hysteroscopic transcervical endomyometrial resection (TREM), levonorgestrel intrauterine system (LNG IUS)

Article Details

How to Cite
YIN, Chang Sheng; LEE, Yi Liang; BAI, Yin- Shium. Case Report with Review of Literature: Pregnancy After TCRM Plus Insertion of LNG IUS. Medical Research Archives, [S.l.], v. 12, n. 8, sep. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5821>. Date accessed: 07 oct. 2024. doi: https://doi.org/10.18103/mra.v12i8.5821.
Section
Case Reports

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