Combined transcervical endometrial resection and levonorgestrel device treatment compared to transcervical endometrial resection for abnormal uterine bleed.
Cohort Studies
Combined Modality Therapy
Contraceptive Agents, Hormonal
/ therapeutic use
Denmark
Endometrial Ablation Techniques
/ statistics & numerical data
Endometrium
/ surgery
Female
Humans
Hysterectomy
/ statistics & numerical data
Intrauterine Devices, Medicated
/ statistics & numerical data
Levonorgestrel
/ therapeutic use
Menorrhagia
/ drug therapy
Middle Aged
Progesterone
/ therapeutic use
Progesterone Congeners
/ therapeutic use
Retrospective Studies
Treatment Outcome
abnormal uterine bleed
amenorrhea
hormone releasing intrauterine contraceptive device
hysterectomy
minimally invasive
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
16
02
2020
revised:
21
06
2020
accepted:
24
06
2020
pubmed:
2
7
2020
medline:
24
3
2021
entrez:
2
7
2020
Statut:
ppublish
Résumé
Transcervical resection of the endometrium (TCRE) is a first-line surgical treatment of abnormal uterine bleeding. However, many women experience unsuccessful results, causing hysterectomy in up 17% of cases. The aim of this study was to describe the odds of hysterectomy in women with abnormal uterine bleeding, treated with TCRE and levonorgestrel intrauterine contraceptive device (TCRE + LNG-IUCD) or TCRE alone. The secondary aim was to analyze the rate of amenorrhea. Designed as a retrospective cohort study, and conducted at Odense University Hospital, Denmark, the study included women with abnormal uterine bleeding, who underwent TCRE from January 2013 to December 2015. The decision of treatment with respect to LNG-IUCD was at the woman's discretion. Data were collected from medical records and a self-reported retrospective bleeding-pattern questionnaire. A multivariate regression model was used, enabling adjustment for potential and identified confounders. Out of 432 women, 276 (62%) consented to inclusion and of these, 16 (4%) were excluded. In total 88 (34%) received combined treatment and 172 (66%) received TCRE alone. Ten women (11%) treated with TCRE + LNG-IUCD underwent hysterectomy, compared with 27 (16%) treated with TCRE alone (OR = 0.69, 95% CI 0.28-1.56; P = .34). Multivariate analysis disclosed a significant effect of TCRE + LNG-IUCD (OR = 0.35, 95% CI 0.13-0.97; P = .04) on hysterectomy. The presence of fibromas was shown to increase the odds of treatment failure, resulting in hysterectomy (OR 2.69, 95% CI 1.15-6.31; P = .02). Furthermore, the incidence of amenorrhea was 59% in the TCRE + LNG-IUCD group and 36% in the TCRE alone group (OR = 2.56, 95% CI 1.46-4.49; P < .01). The study showed significantly lower odds of hysterectomy in the TCRE + LNG-IUCD group when adjusted for confounders. Combination treatment improves the bleeding patterns significantly compared with monotherapy with TCRE.
Substances chimiques
Contraceptive Agents, Hormonal
0
Progesterone Congeners
0
Progesterone
4G7DS2Q64Y
Levonorgestrel
5W7SIA7YZW
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1554-1560Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology.
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