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The levonorgestrel intrauterine system in menopausal hormone replacement therapy: five-year experience
E Suvanto-Luukkonen1, A Kauppila
1Department of Obstetrics and Gynaecology, Oulu University Hospital, Finland. eila.suvanto-luukkonen@oulu.fi
Objective:
To study the long-term effects (5 years) of intrauterine levonorgestrel administration as the progestin part of continuous combined postmenopausal hormone replacement therapy.
Design:
Prospective clinical study.
Setting:
Department of obstetrics and gynecology at a central hospital.
Patient(S):
Twenty postmenopausal women with an intact uterus who had no contraindications to hormone replacement therapy and who wanted to take amenorrhea-inducing hormone replacement therapy to relieve their climacteric symptoms.
Intervention(S):
A percutaneous E2 gel containing 1.5 mg of E2 was administered daily and a levonorgestrel-releasing intrauterine device was used. Endometrial thickness was measured by vaginal ultrasonography. Endometrial sampling was performed yearly.
Main Outcome Measure(S):
Clinical compliance, profiles of bleeding, and endometrial thickness and morphology were monitored during 5 years of follow-up.
Result(S):
Eighteen women completed 1 year of follow-up. Fifteen of these women were willing to continue the study, and 12 of them completed 5 years of follow-up. Spotting was frequent during the first 6 months of the study and declined thereafter. At 1 year, 80% of the women were totally amenorrheic. Of the 15 women who continued the study, 12 were totally amenorrheic and 3 had problems with bleeding. The mean endometrial thickness was < or = 3 mm during the study. Endometrial morphology showed epithelial atrophy accompanied by decidualization of the stroma in all 12 of the women who were followed up for 5 years.
Conclusion(S):
Intrauterine administration of progestin through a levonorgestrel-releasing intrauterine device is a good alternative as the progestin part of continuous combined hormone replacement therapy because it effectively opposes the estrogenic effects on the endometrium and induces amenorrhea in most cases.