Emre Erdem TAŞ, Hüseyin Levent KESKİN, Ayşe Filiz AVŞAR, Gülin Feykan YEĞİN

Evaluation of Intrauterine Devices With Levonorgestrel in Patients With Heavy Menstrual Bleeding According to the Palm-Coein Classification System

Amaç: Ağır menstruel kanamalı olguların tedavisinde levonorgestrel salgılayan intrauterin araç etkinliğinin PALM-COEİN (polip; adenomiyozis; leiomyoma; malignensi; koagülopati; endometrial hiperplazi; ovulatuar disfonksiyon; iatrojenik; henüz sınıflandırılmamış) sistemine göre etkinliğini belirlemek. Gereç ve Yöntemler: Yapısal anomalisi bulunup bulunmamasına göre PALM-COEİN sınıflama sistemi ile gruplandırılan 110 olgu retrospektif olarak incelendi. Oniki aylık tedaviyi tamamlayan 84 olgunun menstruel paternleri, pictorial blood assessment chart (PBAC) skorları, hemoglobin (Hb) değerleri ve endometrial kalınlıklarındaki 1, 6 ve 12. aydaki değişikleri incelendi. İstatistiksel değerlendirmede Independent sample t-tests, repeated-measures ANOVA, post-hoc Bonferroni düzeltmesi ve ki-kare testleri kullanıldı. Bulgular: Tedaviye başlangıçtan 12 ay sonra olguların % 73.8i normal menstruel paterne kavuştu. PBAC skoru COEIN grubunda % 80.6, PALM grubunda ise % 83.9 azaldı. Tedaviye başladıktan 12 ay sonra her iki grupta PBAC skoru ve endometrial kalınlık azalırken (p0.05). Sonuç: Levonorgestrel salgılayan intrauterin araçlar yapısal uterin anomalisi olsun olmasın yüksek oranda etkinlik göstermektedir.

Ağır Menstrüel Kanamalı Olgularda Levonorgestrelli İntrauterin Araç Etkinliğinin PalmCoein Sınıflama Sistemine Göre Değerlendirilmesi

Aim: To evalute the efficacy of a levonorgestrel-releasing intrauterine device for the treatment of patients with heavy menstrual bleeding based on the PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy; hyperplasia-coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; not yet classified) system. Material and Methods: A retrospective study was performed of 110 cases that were grouped according to the PALM-COEIN classification system as those with or without structural abnormalities. For the 84 cases who completed 12 months of treatment, menstrual patterns, pictorial blood assessment chart (PBAC) scores, hemoglobin (Hb) values, and endometrial thickness changes were examined after 1,6 and 12 months. Independent sample t-tests,repeated-measures ANOVA, post-hoc Bonferroni adjustment and chi-squared tests were used for statistical evaluation. Results: After 12 months of treatment, 73.8% of cases achieved a normal menstrual pattern. The PBAC score decreased by 80.6% in the COEIN group and 83.9% in the PALM group. The PBAC scores and endometrial thicknesses were decreased (p0.05). Conclusion: The levonorgestrel-releasing intrauterine device has high levels of effectiveness in cases with or without structural uterine abnormalities.

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