Obstet Gynecol Sci.  2013 Jan;56(1):36-40. 10.5468/OGS.2013.56.1.36.

Effect of myoma size on failure of thermal balloon ablation or levonorgestrel releasing intrauterine system treatment in women with menorrhagia

Affiliations
  • 1Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. ybkimlh@snubh.org
  • 3Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea.

Abstract


OBJECTIVE
The aim of the present study was to identify variables associated with treatment failure in women with menorrhagia who were treated with thermal balloon ablation (TBA) or levonorgestrel releasing intrauterine system (LNG-IUS), and to determine if there are subgroups where one treatment type is more effective than the other.
METHODS
The study included 106 women with menorrhagia who were treated with TBA or LNG-IUS at the study institute between January 2003 and December 2007, with a follow-up period greater than 12 months. Data were collected by retrospective review of medical records. Treatment failure was defined as persistent or recurrent menorrhagia within one year after treatment or hysterectomy at any time during follow-up. The relationships between variables and treatment outcome were analyzed using the chi-square or Fisher's exact test. The treatment outcome of TBA was compared with LNG-IUS.
RESULTS
Sixty-seven women were treated with TBA and 39 women were managed with LNG-IUS. Fifty-two women had a myoma > or =2.5 cm. Treatment failure was observed in 24 women (2 recurrent or persistent menorrhagia and 22 hysterectomies) and myoma size (> or =2.5 cm vs. <2.5 cm) was associated with treatment outcome. TBA and LNG-IUS showed similar treatment outcomes.
CONCLUSION
A large myoma is a risk factor for treatment failure in women with menorrhagia treated with TBA or LNG-IUS.

Keyword

Menorrhagia; Thermal balloon ablation; Levonorgestrel-releasing intrauterine system; Myoma

MeSH Terms

Female
Follow-Up Studies
Humans
Hysterectomy
Levonorgestrel
Medical Records
Menorrhagia
Myoma
Retrospective Studies
Risk Factors
Treatment Failure
Treatment Outcome
Levonorgestrel

Reference

1. Nilsson L, Rybo G. Treatment of menorrhagia. Am J Obstet Gynecol. 1971; 110:713–720. PMID: 5563236.
Article
2. Cooper KG, Parkin DE, Garratt AM, Grant AM. Two-year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes. Br J Obstet Gynaecol. 1999; 106:258–265. PMID: 10426646.
Article
3. Crosignani PG, Vercellini P, Mosconi P, Oldani S, Cortesi I, De Giorgi O. Levonorgestrel-releasing intrauterine device versus hysteroscopic endometrial resection in the treatment of dysfunctional uterine bleeding. Obstet Gynecol. 1997; 90:257–263. PMID: 9241305.
Article
4. Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain. Obstet Gynecol. 1994; 83:566–572. PMID: 8134067.
5. Hart R, Magos A. The alternatives to hysterectomy. Baillieres Best Pract Res Clin Obstet Gynaecol. 1999; 13:271–290. PMID: 10755042.
Article
6. Lethaby A, Hickey M. Endometrial destruction techniques for heavy menstrual bleeding: a Cochrane review. Hum Reprod. 2002; 17:2795–2806. PMID: 12407030.
Article
7. Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivela A, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001; 357:273–277. PMID: 11214131.
Article
8. Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005; (4):CD002126. PMID: 16235297.
Article
9. Apgar BS, Kaufman AH, George-Nwogu U, Kittendorf A. Treatment of menorrhagia. Am Fam Physician. 2007; 75:1813–1819. PMID: 17619523.
10. Iavazzo C, Salakos N, Bakalianou K, Vitoratos N, Vorgias G, Liapis A. Thermal balloon endometrial ablation: a systematic review. Arch Gynecol Obstet. 2008; 277:99–108. PMID: 17805554.
Article
11. Busfield RA, Farquhar CM, Sowter MC, Lethaby A, Sprecher M, Yu Y, et al. A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding. BJOG. 2006; 113:257–263. PMID: 16487195.
Article
12. Gupta B, Mittal S, Misra R, Deka D, Dadhwal V. Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding. Int J Gynaecol Obstet. 2006; 95:261–266. PMID: 16999960.
Article
13. Sowter MC, Lethaby A, Singla AA. Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. 2002; (3):CD001124. PMID: 12137619.
Article
14. Kaunitz AM. Progestin-releasing intrauterine systems and leiomyoma. Contraception. 2007; 75:S130–S133. PMID: 17531604.
Article
15. O'Connor H, Broadbent JA, Magos AL, McPherson K. Medical Research Council randomised trial of endometrial resection versus hysterectomy in management of menorrhagia. Lancet. 1997; 349:897–901. PMID: 9093249.
16. Shaamash AH, Sayed EH. Prediction of successful menorrhagia treatment after thermal balloon endometrial ablation. J Obstet Gynaecol Res. 2004; 30:210–216. PMID: 15210045.
Article
17. Gemer O, Kruchkovich J, Huerta M, Kapustian V, Kroll D, Anteby E. Perioperative predictors of successful hysteroscopic endometrial ablation. Gynecol Obstet Invest. 2007; 63:205–208. PMID: 17159353.
Article
18. Istre O, Skajaa K, Schjoensby AP, Forman A. Changes in serum electrolytes after transcervical resection of endometrium and submucous fibroids with use of glycine 1.5% for uterine irrigation. Obstet Gynecol. 1992; 80:218–222. PMID: 1635735.
19. Loffer FD. Endometrial ablation in patients with myomas. Curr Opin Obstet Gynecol. 2006; 18:391–393. PMID: 16794418.
Article
20. Shamonki MI, Ziegler WF, Badger GJ, Sites CK. Prediction of endometrial ablation success according to perioperative findings. Am J Obstet Gynecol. 2000; 182:1005–1007. PMID: 10819809.
Article
21. Shaw RW, Symonds IM, Tamizian O, Chaplain J, Mukhopadhyay S. Randomised comparative trial of thermal balloon ablation and levonorgestrel intrauterine system in patients with idiopathic menorrhagia. Aust N Z J Obstet Gynaecol. 2007; 47:335–340. PMID: 17627692.
Article
22. Davis JR, Maynard KK, Brainard CP, Purdon TF, Sibley MA, King DD. Effects of thermal endometrial ablation. Clinicopathologic correlations. Am J Clin Pathol. 1998; 109:96–100. PMID: 9426524.
23. Istre O, Langebrekke A. Repeat hysteroscopic surgery reduces the hysterectomy rate after endometrial and myoma resection. J Am Assoc Gynecol Laparosc. 2003; 10:247–251. PMID: 12732779.
Article
24. McCausland AM, McCausland VM. Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention. J Minim Invasive Gynecol. 2007; 14:399–406. PMID: 17630156.
Article
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