The levonorgestrel intrauterine system with a transdermal estrogen for climacteric complaints: clinical and endometrial responses

The levonorgestrel intrauterine system with a transdermal estrogen for

climacteric complaints: clinical and endometrial responses

V.N. Prilepskaya, L.I. Ostreikova

Research Centre of Obstetrics and Gynecology and Perinatology, Academy of

Medical Sciences of the Russian Federation, Moscow, Russia

The aim of this research was to study clinical efficiency and acceptability

of transdermal estrogen (Klimara) in combination with levonorgestrel

intrauterine system (LNG-IUS) for the treatment of climacteric complaints of

premenopause women as well as to determine the influence of LNG-IUD on the

condition of endometrium.

Material and method: We had twenty five premenopause women. The

average age of the subjects was ranging from 45 to 52 years.We dealt with

patients seeking treatment for climacteric symptoms. Major complaints were hot

flushes, sweating, sleep disturbances and irritability or depression. These

climacteric symptoms appeared against delay periods.

Methods of investigation: We used Kupperman index to describe

climacteric symptoms; serum concentration of estradiol was thoroughly observed

within the period of a 1-year treatment. The efficiency of the progestin therapy

was controlled by transvaginal ultrasonography and by the examination of biopsy

samples obtained. The duration of follow-up was 12 months. The intervals of

follow-up were 6 months.

Results: Curing effect on climacteric symptoms was observed in

decrease or disappearance of hot flushes and hypergedroses in 3 months’ time

(45%). After 6 months Kupperman index became noticeably lower (p50.01). During

the follow-up year, serum estradiol concentration got significantly higher

(p50.0001) and the average concentration was 182+17 pg/ml after 6 months and 260

+19 pg/ml after 12 months. During the first half of the follow-up year, 32% of

the women had amenorrhea and one year after the beginning of the study their

number rose up to 84%. Histological examination showed that the typical finding

in the endometrium was without any indications of functional activity with 90%

of women. Intrauterine levonorgestrel-releasing system induces the

transformation of the endometrium characterised by extensive decidualisation of

the stroma, cells associated with leukocyte infiltrate, atrophy of the glandular,

glandular epithelium of the indifferent type. After 12 months’ therapy, all

women had atrophic epithelium with pronounced decidual reaction in the stroma.

No signs of proliferation were observed in any of the endometrial samples.

Conclusion: Thus, levonorgestrel intrauterine system with estrogen in

HRT is an effective and acceptable method of treating climacteric symptoms. It

is extraordinarily important that the progesterone released from the IUD

prevents the endometrial proliferation induced by estrogen.

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